MEDICARE: PHYSICIANS CHOICE DIALYSIS OF ALABAMA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	S2601	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S2601	OTHER	AL	STATE LICENSE

General Provider Information

NPI Number	:	1063476489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS CHOICE DIALYSIS OF ALABAMA LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4268
Fax Number	:	877-238-0567

Provider Business Practice Location Address
First Line	:	125 HOSPITAL DRIVE
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36092-1626
Country	:	US
Telephone Number	:	334-514-2037
Fax Number	:	334-514-9568

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER, TREASURER
Name	:	JOHN WINSTEL
Credential	:
Telephone Number	:	253-733-4501

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	03/01/2023

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