Organization
WESTSIDE DIALYSIS UNIT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOSES C EJIOFOR SR. M.D. (PHYSICIAN)
(501) 603-9277
Entity
Organization
Contact information
Practice address
1515 KANIS PARK DR, SUITE A, LITTLE ROCK, AR 72205-4569
(501) 603-9277
(501) 603-9877
Mailing address
1515 KANIS PARK DR, SUITE B, LITTLE ROCK, AR 72205-4569
(501) 603-9277
(501) 603-9277
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
05
—
211230134
—
AR
Enumeration date
02/25/2011
Last updated
07/21/2022
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