Organization
DIALYSIS MANAGEMENT GROUP LLC
Active
Other names
Porcupine Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN RADA (PRESIDENT)
(605) 390-0910
Entity
Organization
Contact information
Practice address
HCR 49, PORCUPINE, SD 57772-0000
(605) 718-0392
Mailing address
HCR 49 BOX 82C, PORCUPINE, SD 57772-0000
(605) 718-0392
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
—
5400390
—
SD
Enumeration date
10/15/2010
Last updated
11/22/2013
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