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General NPI Number Information
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NPI Number | 1881702603
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Entity Type | Organization
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Legal Business Name | WISCONSIN DIALYSIS, INC.
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 3034 FISH HATCHERY RD
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City | FITCHBURG
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State | WI
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Zip | 53713-3125
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Country | US
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Telephone | 608-270-5600
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Fax | 608-270-5602
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Provider Business Mailing Address
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Address Line | 3034 FISH HATCHERY RD
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City | FITCHBURG
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State | WI
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Zip | 53713-3125
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Country | US
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Telephone | 608-270-5600
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Fax | 608-270-5602
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KRISTINE HOLMES
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Credential |
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Telephone | 608-270-5624
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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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