Organization
WISCONSIN DIALYSIS, INC.
Active
Other names
East Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE HOLMES (AUTHORIZED OFFICIAL)
(608) 270-5624
Entity
Organization
Contact information
Practice address
4600 AMERICAN PKWY, STE 108, MADISON, WI 53718-8337
(608) 243-3003
(608) 243-3005
Mailing address
3034 FISH HATCHERY RD, FITCHBURG, WI 53713-3125
(608) 270-5600
(608) 270-5602
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
—
42059900
—
WI
Enumeration date
08/29/2006
Last updated
06/24/2019
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