Organization
GREATER LAFAYETTE HEALTH SERVICES
Active
Other names
Montgomery County Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRANCE E WILSON (CHIEF EXECUTIVE OFFICER)
(765) 423-6161
Entity
Organization
Contact information
Practice address
1710 LAFAYETTE RD, CRAWFORDSVILLE, IN 47933-1033
(765) 359-2224
Mailing address
1710 LAFAYETTE RD, CRAWFORDSVILLE, IN 47933-1033
(765) 359-2224
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
IN
Other
Enumeration date
09/22/2006
Last updated
08/22/2020
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