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Organization

FORT SMITH REGIONAL DIALYSIS CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAURA PALMER (EXECUTIVE DIRECTOR)
(479) 755-6750
Entity
Organization

Contact information

Practice address
2201 BROOKEN HILL DR, FORT SMITH, AR 72908-8611
(479) 755-6700
(479) 755-6704
Mailing address
2201 BROOKEN HILL DR, FORT SMITH, AR 72908-8611
(479) 755-6700
(479) 755-6704

Taxonomy

Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100728340A
OK
01
12501
AR BLUE CROSS
AR
05
134859734
AR
05
140066002
AR
Enumeration date
05/23/2005
Last updated
06/13/2012
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