Organization
CALAVERAS DIALYSIS LLC
Active
Other names
PAPAGO DIALYSIS CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
(253) 733-4500
Entity
Organization
Contact information
Practice address
5115 E THOMAS RD, STE 115, PHOENIX, AZ 85018-7914
(602) 840-4124
(602) 840-3362
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-5893
(877) 850-7073
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
OTC 0725
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181876
—
AZ
Enumeration date
12/10/2012
Last updated
10/01/2013
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