Organization
DIALYSIS SERVICES OF PINEVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA ANNE BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
12904 ROBERT L. MADON BYPASS, SUITE 1, PINEVILLE, KY 40977-8063
(606) 337-1110
(606) 337-1190
Mailing address
12904 ROBERT L. MADON BYPASS, SUITE 1, PINEVILLE, KY 40977-8063
(606) 337-1110
(606) 337-1190
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
—
7100240520
—
KY
Enumeration date
09/10/2012
Last updated
01/10/2023
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