Organization
ABITA SQUARE DIALYSIS, LLC
Active
Organization
ABITA SQUARE DIALYSIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN E ANGELO MD (ADMINISTRATOR)
(985) 845-9000
Entity
Organization
Contact information
Practice address
397 HIGHWAY 21, SUITE 601, MADISONVILLE, LA 70447-3407
(985) 845-9000
Mailing address
397 HIGHWAY 21, SUITE 601, MADISONVILLE, LA 70447-3407
(985) 845-9000
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
APPLYING FOR
LA
Other
Enumeration date
10/07/2009
Last updated
10/07/2009
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