Organization
LA GRANGE DIALYSIS LLC
Active
Other names
Corydon Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
JIM HILGER (VICE PRESIDENT)
(253) 382-1919
Entity
Organization
Contact information
Practice address
1937 OLD HIGHWAY 135 NW, CORYDON, IN 47112-2013
(812) 738-5200
(812) 738-4935
Mailing address
5200 VIRGINIA WAY, STE 400 L&C, BRENTWOOD, TN 37027-7569
(615) 320-4521
(866) 594-2894
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
—
200889000A
—
IN
05
—
7100049230
—
KY
Enumeration date
06/24/2008
Last updated
09/25/2008
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