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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