Provider Demographics
NPI:1609037373
Name:MOUNTAIN WEST DIALYSIS SERVICES LLC
Entity Type:Organization
Organization Name:MOUNTAIN WEST DIALYSIS SERVICES LLC
Other - Org Name:ARVADA DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-733-4500
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:L&C DEPT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-341-5893
Mailing Address - Fax:877-850-7073
Practice Address - Street 1:9950 W 80TH AVE
Practice Address - Street 2:STE 25
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-3914
Practice Address - Country:US
Practice Address - Phone:303-456-9556
Practice Address - Fax:303-456-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45706794Medicaid
CO45706794Medicaid