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General NPI Number Information
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NPI Number | 1881850857
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Entity Type | Organization
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Legal Business Name | GREATER BOONE DIALYSIS, LLC
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 300 4TH ST.
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City | DANVILLE
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State | WV
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Zip | 25053
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Country | US
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Telephone | 304-720-3456
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Fax |
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Provider Business Mailing Address
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Address Line | 24 MCCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-1476
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Country | US
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Telephone | 304-720-2222
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Fax | 304-720-2322
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KATHY CARPER
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Credential |
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Telephone | 304-720-2222
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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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