LA GRANGE DIALYSIS LLC NPI 1710079876

NPI Information

LA GRANGE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Louisville, KY. LA GRANGE DIALYSIS LLC NPI is 1710079876. The provider is registered as an organization entity type.
The provider Is Doing Business As West Broadway Dialysis.

The provider's business location address is:

720 W BROADWAY
LOUISVILLE, KY
ZIP 40202-216
Phone: (502) 584-2059
Fax: (502) 584-2835

The provider's authorized official is Thomas O Usilton .
The authorized official title is Sr Vice President and has the following contact phone number (770) 541-7922.

The CLIA number assigned to this NPI record is 18D1061420 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/28/2006 and was last updated on 8/1/2007.

Taxonomy Codes

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