Organization
SPRAGUE DIALYSIS LLC
Active
Other names
Bridgeton Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
333 IRVING AVE, BRIDGETON, NJ 08302-2123
(856) 575-4200
(856) 453-0174
Mailing address
5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6410
(888) 662-8259
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
25050
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0598917
—
NJ
Enumeration date
12/09/2016
Last updated
07/20/2020
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