Organization
ISD RENAL INC
Active
Other names
Lake Avenue Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
(253) 272-1916
Entity
Organization
Contact information
Practice address
3909 LAKE AVE, FORT WAYNE, IN 46805-5545
(260) 420-2666
(260) 424-2036
Mailing address
5200 VIRGINIA WAY, LICENSURE & CERTIFICATION, BRENTWOOD, TN 37027-7569
(615) 341-6374
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
05/26/2006
Last updated
07/03/2012
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