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General NPI Number Information
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NPI Number | 1467254714
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Entity Type | Organization
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Legal Business Name | BITTERROOT HEALTH DIALYSIS LLC
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 1270 WESTWOOD DR
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City | HAMILTON
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State | MT
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Zip | 59840-2345
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Country | US
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Telephone | 406-961-7105
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Fax | 406-961-7160
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Provider Business Mailing Address
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Address Line | 1633 CHURCH ST STE 500
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City | NASHVILLE
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State | TN
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Zip | 37203-2948
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Country | US
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Telephone | 615-327-3061
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Fax | 615-963-9730
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONOVAN SCHULTZ
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Credential |
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Telephone | 615-327-3061
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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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