Organization
RENALSOUTH OF ROGERS, LLC
Active
Organization
RENALSOUTH OF ROGERS, LLC
Active
Parent organization
RENALSOUTH OF ARKANSAS
Organization subpart
Yes
Provider details
NPI number
Legal business name
RENALSOUTH OF ARKANSAS
Authorized official
CHARLOTTE P ANTHONY (COO)
(205) 271-2129
Entity
Organization
Contact information
Practice address
101 N 37TH ST, ROGERS, AR 72756-0301
(205) 271-2129
Mailing address
117 GEMINI CIR, SUITE 418, BIRMINGHAM, AL 35209-5874
(205) 271-2129
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12D01
BCBS
AR
05
—
190358134
—
AR
Enumeration date
03/18/2010
Last updated
03/26/2014
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