Organization
SOUTHEASTERN RENAL DIALYSIS L.C.
Active
Parent organization
SOUTHEASTERN RENAL DIALYSIS L.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEASTERN RENAL DIALYSIS L.C.
Authorized official
MRS. MARY LIECHTY (ADMINISTRATOR)
(319) 385-6728
Entity
Organization
Contact information
Practice address
4703 AVENUE L, FORT MADISON, IA 52627-9505
(319) 372-7996
Mailing address
507 S WHITE ST, MT PLEASANT, IA 52641-2625
(319) 385-6564
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
08/31/2006
Last updated
03/16/2012
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