Organization
RENAL TREATMENT CENTERS SOUTHEAST LP
Active
Other names
Granbury Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHIEF ACCOUNTING OFFICER/ TREASURER)
(253) 733-4500
Entity
Organization
Contact information
Practice address
1200 PALUXY MEDICAL CIR, STE 100, GRANBURY, TX 76048-5696
(817) 579-1417
(817) 579-9605
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6764
(833) 781-6999
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
—
3394280-01
—
TX
Enumeration date
01/20/2012
Last updated
09/16/2019
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