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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