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General NPI Number Information
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NPI Number | 1922184563
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Entity Type | Organization
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Legal Business Name | PURITY DIALYSIS CENTERS, INC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 123 HOSPITAL DR STE 1004
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City | WATERTOWN
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State | WI
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Zip | 53098-3390
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Country | US
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Telephone | 920-206-0666
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Fax | 920-206-0688
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Provider Business Mailing Address
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Address Line | 2301 SUN VALLEY DR STE 200
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City | DELAFIELD
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State | WI
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Zip | 53018-2318
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Country | US
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Telephone | 262-646-4162
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Fax | 262-646-2498
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MS. TINA M WALDRON
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Credential |
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Telephone | 262-646-6426
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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 | WI
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