Organization
CANYONLANDS DIALYSIS LLC
Active
Other names
Leesburg Virginia Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JIM HILGER (VICE PRESIDENT)
(253) 382-1919
Entity
Organization
Contact information
Practice address
224 CORNWALL ST NW, LEESBURG, VA 20176-2701
(571) 258-1362
(571) 258-1342
Mailing address
5200 VIRGINIA WAY, STE 400 L&C, BRENTWOOD, TN 37027-7569
(615) 320-4521
(866) 594-2894
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
—
1669631297
—
VA
Enumeration date
06/09/2008
Last updated
11/25/2008
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