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
1213 S GEAR AVE, WEST BURLINGTON, IA 52655-1679
(319) 758-0691
(319) 758-0392
Mailing address
507 S WHITE ST, MT PLEASANT, IA 52641-2625
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0625103
—
IA
Enumeration date
04/21/2006
Last updated
03/16/2012
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