MEDICARE: LOS ANGELES DIALYSIS CENTER

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	930000446	CA

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

General Provider Information

NPI Number	:	1558320366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES DIALYSIS CENTER

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	SUTIE 400 L&C
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-341-5895
Fax Number	:	866-890-5560

Provider Business Practice Location Address
First Line	:	3901 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-1112
Country	:	US
Telephone Number	:	323-294-1310
Fax Number	:	323-294-4034

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JAMES K HILGER
Credential	:
Telephone Number	:	253-382-1919

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	05/03/2011

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Directions to “LOS ANGELES DIALYSIS CENTER ” Practice Location

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