Organization
ON SITE DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BLAGG (CREDENTIALING)
(901) 821-0338
Entity
Organization
Contact information
Practice address
65 WREN ST, HERNANDO, MS 38632-4433
(662) 806-7480
Mailing address
PO BOX 382926, GERMANTOWN, TN 38183-2926
(662) 806-7480
Taxonomy
Speciality
Code
Description
License number
State
163WH0500X
Hemodialysis Registered Nurse
Primary
—
—
Other
Enumeration date
12/12/2022
Last updated
12/12/2022
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