MEDICARE: MESQUITE DIALYSIS CENTER 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	PENDING	NV

General Provider Information

NPI Number	:	1811180904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESQUITE DIALYSIS CENTER LLC

Provider Business Mailing Address
First Line	:	807 CANYON GREENS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0836
Country	:	US
Telephone Number	:	702-274-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 FALCON RIDGE PKWY STE 400
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-8881
Country	:	US
Telephone Number	:	702-274-3630
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAM JANGA
Credential	:
Telephone Number	:	702-274-3630

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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