Organization
DAVITA DAKOTA DIALYSIS CENTER LLC
Active
Other names
Fargo Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
4474 23RD AVE S, STE M, FARGO, ND 58104-8795
(701) 281-3900
(701) 282-2635
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1453372
—
ND
Enumeration date
08/05/2007
Last updated
10/15/2024
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