MEDICARE: PLATEAU DIALYSIS 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

General Provider Information

NPI Number	:	1134488133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATEAU DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT-STE400
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-341-6789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 E LITTLE CREEK RD
Second Line	:	STE B
City	:	NORFOLK
State	:	VA
Zip	:	23518-4203
Country	:	US
Telephone Number	:	757-587-9156
Fax Number	:	757-587-9720

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JAMES K HILGER
Credential	:
Telephone Number	:	253-272-1916

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/15/2012

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Directions to “PLATEAU DIALYSIS LLC ” Practice Location

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