Organization
RAYBURN DIALYSIS LLC
Active
Organization
RAYBURN DIALYSIS LLC
Active
Other names
Odessa Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
(253) 382-1919
Entity
Organization
Contact information
Practice address
6005 EASTRIDGE RD, ODESSA, TX 79762-5019
(432) 362-3008
(432) 362-3302
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4550
(866) 500-8578
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
110111
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027740
KIDNEY PROGRAM
TX
05
—
297639101
—
TX
Enumeration date
12/06/2011
Last updated
12/21/2012
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