MEDICARE: MOUNTAIN WEST DIALYSIS SERVICES 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

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	:	1609037373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN WEST DIALYSIS SERVICES 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	:	615-341-5893
Fax Number	:	877-850-7073

Provider Business Practice Location Address
First Line	:	9950 W 80TH AVE
Second Line	:	STE 25
City	:	ARVADA
State	:	CO
Zip	:	80005-3914
Country	:	US
Telephone Number	:	303-456-9556
Fax Number	:	303-456-8836

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JAMES K HILGER
Credential	:
Telephone Number	:	253-733-4500

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	12/19/2013

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