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Organization

RANDOLPH DIALYSIS LLC

Active
Other names
Three Rivers Dialysis
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization

Contact information

Practice address
6721 OLD TRAIL RD, STE 100, FORT WAYNE, IN 46809-2655
(260) 478-8582
(260) 478-8566
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961

Taxonomy

Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300009689A
IN
Enumeration date
02/19/2014
Last updated
12/15/2022
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