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General NPI Number Information
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NPI Number | 1295752095
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Entity Type | Organization
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Legal Business Name | WEST PALM DIALYSIS, LLC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 1522 N DIXIE HWY WEST PAL DIALYSIS, LLC - CKD SERVICES
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2720
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Country | US
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Telephone | 561-833-5355
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Fax | 561-833-9193
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Provider Business Mailing Address
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Address Line | 920 WINTER ST FMCNA CKD SERVICES
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City | WALTHAM
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State | MA
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Zip | 02451-1521
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Country | US
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Telephone | 781-699-4160
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Fax | 781-699-4046
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Authorized Official
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Title or Position | TREASURER
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Name | MR. MARK FAWCETT
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Credential |
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Telephone | 781-699-2668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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