MEDICARE: DIALYSIS MANAGEMENT CORP

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	:	1588923189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS MANAGEMENT CORP

Provider Business Mailing Address
First Line	:	6240 E SHELBY DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38141-7735
Country	:	US
Telephone Number	:	901-654-3139
Fax Number	:	901-654-3156

Provider Business Practice Location Address
First Line	:	6222 E SHELBY DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38141-7735
Country	:	US
Telephone Number	:	901-654-3139
Fax Number	:	901-654-3156

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DARRYL SMITH
Credential	:
Telephone Number	:	901-654-3139

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	04/30/2013

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