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General NPI Number Information
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NPI Number | 1760092597
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Entity Type | Organization
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Legal Business Name | FORT SMITH REGIONAL DIALYSIS CENTER, LLC
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 256 NORTHRIDGE DRIVE E
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City | VAN BUREN
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State | AR
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Zip | 72956
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Country | US
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Telephone | 479-755-6754
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Fax | 479-755-6849
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Provider Business Mailing Address
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Address Line | PO BOX 181210
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City | FORT SMITH
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State | AR
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Zip | 72918-1210
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Country | US
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Telephone | 479-755-6754
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Fax | 479-755-6849
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAURA ANNE PALMER
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Credential |
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Telephone | 479-755-6750
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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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