Organization
SOUTHWOOD PARK DIALYSIS LLC
Active
Other names
Prairieville Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
17123 COMMERCE CENTRE DR, PRAIRIEVILLE, LA 70769-3481
(225) 877-2001
(225) 877-2002
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 997-4210
(866) 935-5481
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
—
2468367
—
LA
Enumeration date
01/11/2016
Last updated
09/14/2022
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