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General NPI Number Information
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NPI Number | 1811315823
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Entity Type | Organization
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Legal Business Name | FORREST CITY DIALYSIS
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 5200 VIRGINIA WAY L & C DEPARTMENT
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City | BRENTWOOD
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State | TN
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Zip | 37027
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Country | US
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Telephone | 615-320-4236
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY L & C DEPARTMENT
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City | BRENTWOOD
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State | TN
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Zip | 37027
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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 | CAO
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Name | JAMES HILGER
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Credential |
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Telephone | 303-876-6000
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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 | 1457673345
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License Number State | AR
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Taxonomy #2
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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 | 04D1096838
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License Number State | AR
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