Organization
MOSES DIALYSIS UNIT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY NELSON (CHIEF EXECUTIVE OFFICER)
(906) 643-0455
Entity
Organization
Contact information
Practice address
220 BURDETTE ST, SAINT IGNACE, MI 49781-1712
(906) 643-0408
(906) 643-7821
Mailing address
220 BURDETTE ST, SAINT IGNACE, MI 49781-1712
(906) 643-0408
(906) 643-7821
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
495001
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4450183
—
MI
Enumeration date
11/01/2006
Last updated
08/22/2020
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