Organization
OSCEOLA DIALYSIS
Active
Organization
OSCEOLA DIALYSIS
Active
Other names
ISD Renal Inc fka DSI Renal Inc
Organization subpart
No
Provider details
NPI number
Authorized official
KENT THIRY CHAIRMAN (CEO)
(303) 876-6000
Entity
Organization
Contact information
Practice address
1423 PACIFIC AVE, TACOMA, WA 98402-4203
(253) 382-1752
Mailing address
1332 W KEISER AVE, OSCEOLA, AR 72370-2919
(870) 563-4901
(870) 563-4959
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
04D0881442
AR
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
1174578595
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161527134
—
AR
Enumeration date
04/09/2014
Last updated
04/09/2014
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