Organization
JEDBURG DIALYSIS LLC
Active
Organization
JEDBURG DIALYSIS LLC
Active
Other names
Jedburg Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHEIF ACCOUNTING OFFICER)
(253) 733-4500
Entity
Organization
Contact information
Practice address
2897 W 5TH NORTH ST, SUMMERVILLE, SC 29483-9674
(843) 873-3955
(843) 873-0266
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4230
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ERD-0183
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ERD183
—
SC
Enumeration date
01/23/2008
Last updated
09/30/2015
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