Organization
FORREST CITY DIALYSIS
Active
Organization
FORREST CITY DIALYSIS
Active
Other names
Renal Treatment Ctrs Southeast LP
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES HILGER (CAO)
(303) 876-6000
Entity
Organization
Contact information
Practice address
5200 VIRGINIA WAY, L & C DEPARTMENT, BRENTWOOD, TN 37027
(615) 320-4236
Mailing address
5200 VIRGINIA WAY, L & C DEPARTMENT, BRENTWOOD, TN 37027
(615) 320-4268
(877) 238-0567
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
04D1096838
AR
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
1457673345
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180379134
—
AR
Enumeration date
04/07/2014
Last updated
06/15/2018
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