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General NPI Number Information
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NPI Number | 1801995584
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Entity Type | Organization
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Legal Business Name | AMERI-TECH KIDNEY CENTER
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 1138 S BOWEN RD
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City | ARLINGTON
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State | TX
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Zip | 76013-2204
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Country | US
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Telephone | 817-265-7115
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Fax | 817-801-7386
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Provider Business Mailing Address
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Address Line | 1138 S BOWEN RD
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City | ARLINGTON
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State | TX
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Zip | 76013-2204
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Country | US
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Telephone | 817-265-7115
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Fax | 817-801-7386
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. LEIF GUTTORMSEN
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Credential |
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Telephone | 817-265-7115
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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 | 008084
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License Number State | TX
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