Provider Demographics
NPI:1205390192
Name:SATELLITE HEALTHCARE OF LAGRANGE, LLC
Entity Type:Organization
Organization Name:SATELLITE HEALTHCARE OF LAGRANGE, LLC
Other - Org Name:SATELLITE HEALTHCARE LAGRANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-404-3600
Mailing Address - Street 1:PO BOX 45867
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0867
Mailing Address - Country:US
Mailing Address - Phone:480-436-2496
Mailing Address - Fax:480-692-2904
Practice Address - Street 1:109 PARKER DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-6436
Practice Address - Country:US
Practice Address - Phone:706-530-2804
Practice Address - Fax:706-530-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment