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General NPI Number Information
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NPI Number | 1346203825
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Entity Type | Organization
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Legal Business Name | GREATER LAS VEGAS DIALYSIS LLC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 2250 S RANCHO DR STE 115
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City | LAS VEGAS
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State | NV
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Zip | 89102-4456
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Country | US
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Telephone | 702-795-1771
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Fax | 702-795-1794
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY L&C DEPARTMENT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7569
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Country | US
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Telephone | 615-341-6814
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Fax | 800-293-8405
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Authorized Official
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Title or Position | CHIEF ACCOUNTING OFFICER
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Name | JOHN D WINSTEL
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Credential |
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Telephone | 253-733-4501
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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 | 2948ESR
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License Number State | NV
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