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General NPI Number Information
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NPI Number | 1558018655
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Entity Type | Organization
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Legal Business Name | PREMIER DIALYSIS SERVICE TENNESSEE LLC
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 11762 DOUGLASS ST STE 103
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City | ARLINGTON
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State | TN
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Zip | 38002-4489
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Country | US
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Telephone | 888-543-6390
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 N MAIN ST
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City | LAPEER
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State | MI
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Zip | 48446-1346
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | JOSHUA DIPZINSKI
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Credential | RN
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Telephone | 888-543-6390
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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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