Organization
KINGSTON DIALYSIS CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOEEN A HATAB PH.D. (ADMINISTRATOR)
(865) 850-2900
Entity
Organization
Contact information
Practice address
1208 N KENTUCKY ST, KINGSTON, TN 37763-2328
(865) 248-8006
Mailing address
1208 N KENTUCKY ST, KINGSTON, TN 37763-2328
(865) 248-8006
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0000000159
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000159
STATE LICENSE
TN
Enumeration date
05/18/2010
Last updated
05/18/2010
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