Organization
RAVINE DIALYSIS LLC
Active
Other names
Beech Fork Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
(253) 733-4500
Entity
Organization
Contact information
Practice address
600 MCGINNIS DR, WAYNE, WV 25570
(304) 272-3703
(304) 272-3476
Mailing address
5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3051
(800) 246-8346
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
—
1215389747
—
WV
Enumeration date
07/08/2016
Last updated
08/16/2018
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