Organization
TYLER DIALYSIS LLC
Active
Other names
Lourdes Mt Laurel Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
130 GAITHER DR, STE 172, MOUNT LAUREL, NJ 08054-1715
(856) 222-4195
(856) 235-4842
Mailing address
5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6410
(888) 662-8259
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
22204
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0318191
—
NJ
Enumeration date
09/10/2012
Last updated
07/06/2020
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