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General NPI Number Information
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NPI Number | 1700842655
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Entity Type | Organization
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Legal Business Name | GREENWOOD DIALYSIS LLC
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 1345 N LANSING AVE
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City | TULSA
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State | OK
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Zip | 74106-5911
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Country | US
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Telephone | 918-585-8811
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Fax | 918-585-5506
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY L&C DEPT
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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 | 615-320-4268
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Fax | 877-238-0567
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Authorized Official
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Title or Position | VICE PRESIDENT, LICENSURE & CERTIFI
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Name | SAM T WEY
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Credential |
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Telephone | 615-341-6691
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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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