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General NPI Number Information
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NPI Number | 1679568778
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Entity Type | Organization
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Legal Business Name | GREATER CHARLESTON DIALYSIS, PLLC
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-1476
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Country | US
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Telephone | 304-720-2222
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Fax | 304-720-2322
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Provider Business Mailing Address
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Address Line | 24 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-1476
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Country | US
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Telephone | 304-720-2222
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Fax | 304-720-2322
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JULIAN L. ESPIRITU JR.
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Credential | M.D.
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Telephone | 304-720-2222
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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 | 43517
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License Number State | WV
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