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Organization

HEMODIALYSIS ASSOC PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. FREDERICK IVAN ENDE MD (PRESIDENT)
(804) 861-9555
Entity
Organization

Contact information

Practice address
3335 S CRATER RD, PETERSBURY, VA 23805
(804) 862-5261
Mailing address
425 SANDHURST DR, PETERSBURG, VA 23805-7862
(804) 861-9555
(804) 861-9555

Taxonomy

Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
005522
ANTHEM BC/BS
05
8915229
VA
Enumeration date
10/10/2006
Last updated
01/23/2009
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