Organization
DIALYSIS MANAGEMENT GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS C RAYMOND MD (MEDICAL DIRECTOR)
(605) 718-0391
Entity
Organization
Contact information
Practice address
101 MAIN STREET, PORCUPINE, SD 57772
(605) 718-0391
Mailing address
101 MAIN ST, PORCUPINE, SD 57772
(605) 718-0391
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
05
—
5400390
—
SD
Enumeration date
09/22/2006
Last updated
08/10/2009
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