Organization
RENAL TREATMENT CENTERS - SOUTHEAST, LP
Active
Other names
Fort Walton Beach Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O. USILTON JR. (GROUP VICE PRESIDENT)
(770) 541-7922
Entity
Organization
Contact information
Practice address
1110 HOSPITAL RD, SUITE A, FORT WALTON BEACH, FL 32547-6644
(850) 862-6989
(850) 862-0014
Mailing address
5200 VIRGINIA WAY, STE. 400 L&C, BRENTWOOD, TN 37027-7569
(615) 320-4218
(303) 209-7825
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
04/21/2006
Last updated
07/12/2007
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