=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356302848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDNEY CENTERS OF MICHIGAN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2006
-----------------------------------------------------
Last Update Date | 12/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7960 GRAND RIVER RD STE 210
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-7336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-225-6288
-----------------------------------------------------
Fax | 810-225-6291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 VIRGINIA WAY L&C DEPT
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-467-4736
-----------------------------------------------------
Fax | 615-320-4487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ACCOUNTING OFFICER
-----------------------------------------------------
Name | JAMES K HILGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-733-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------