Organization
LA GRANGE DIALYSIS LLC
Active
Other names
West Broadway Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O USILTON JR. (SR VICE PRESIDENT)
(770) 541-7922
Entity
Organization
Contact information
Practice address
720 W BROADWAY, LOUISVILLE, KY 40202-2216
(502) 584-2059
(502) 584-2835
Mailing address
5200 VIRGINIA WAY, STE 400 L&C, BRENTWOOD, TN 37027-7569
(615) 320-4218
(303) 209-7825
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
09/28/2006
Last updated
08/01/2007
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