Organization
MATHESON DIALYSIS LLC
Active
Organization
MATHESON DIALYSIS LLC
Active
Other names
Diamond State Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
9022 LANDERS RD STE E, NORTH LITTLE ROCK, AR 72117-1599
(501) 834-1449
(501) 834-1450
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
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
—
229436134
—
AR
Enumeration date
02/09/2017
Last updated
08/13/2021
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