Organization
DENTSVILLE KIDNEY CENTER 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
201 COLUMBIA MALL BLVD, SUITE 141, COLUMBIA, SC 29223-7536
(803) 865-1068
(803) 865-1089
Mailing address
201 COLUMBIA MALL BLVD, SUITE 141, COLUMBIA, SC 29223-7536
(803) 865-1068
(803) 865-1089
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
—
RE0065
—
SC
Enumeration date
11/19/2010
Last updated
01/10/2023
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