Organization
PURITY DIALYSIS CENTERS, INC
Active
Other names
Fort Atkinson Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TINA M WALDRON (BILLING SUPERVISOR)
(262) 646-6426
Entity
Organization
Contact information
Practice address
525 HANDEYSIDE LN, FORT ATKINSON, WI 53538-1281
(920) 563-8665
(920) 563-8643
Mailing address
2301 SUN VALLEY DR STE 200, DELAFIELD, WI 53018-2318
(262) 646-4162
(262) 646-2498
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
522533
—
WI
01
—
52D0988777
FADC CLIA #
WI
Enumeration date
10/27/2006
Last updated
05/13/2010
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