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General NPI Number Information
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NPI Number | 1669631297
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Entity Type | Organization
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Legal Business Name | CANYONLANDS DIALYSIS LLC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 224 CORNWALL ST NW
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City | LEESBURG
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State | VA
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Zip | 20176-2701
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Country | US
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Telephone | 571-258-1362
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Fax | 571-258-1342
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY STE 400 L&C
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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 | 615-320-4521
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Fax | 866-594-2894
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JIM HILGER
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Credential |
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Telephone | 253-382-1919
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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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