Organization
WESTERN SKIES DIALYSIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN LETARTE M.D. (PRESIDENT)
(520) 836-5883
Entity
Organization
Contact information
Practice address
1041 N ARIZOLA RD, CASA GRANDE, AZ 85122-6003
(520) 836-5883
(520) 836-2728
Mailing address
1041 N ARIZOLA RD, CASA GRANDE, AZ 85122-6003
(520) 836-5883
(520) 836-2728
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
OTC 0576
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1155239
—
AZ
Enumeration date
01/09/2007
Last updated
09/21/2010
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