Organization
DEGRAY DIALYSIS
Active
Other names
Renal Treatment Ctrs Southeast LP
Organization subpart
No
Provider details
NPI number
Authorized official
KENT THIRY CHAIRMAN (CEO)
(303) 876-6000
Entity
Organization
Contact information
Practice address
1423 PACIFIC AVE, TACOMA, WA 98402-4203
(253) 382-1752
Mailing address
312 PROFESSIONAL PARK DR, STE H, ARKADELPHIA, AR 71923-5315
(870) 246-3021
(870) 245-3766
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
04D0466009
AR
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
1184968604
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200361034
—
AR
Enumeration date
04/07/2014
Last updated
04/07/2014
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