Provider Demographics
NPI:1699836411
Name:METHODIST HEALTHCARE DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-1400
Mailing Address - Street 1:6400 SHELBY VIEW DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7659
Mailing Address - Country:US
Mailing Address - Phone:901-516-1400
Mailing Address - Fax:901-380-8081
Practice Address - Street 1:8071 WINCHESTER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8206
Practice Address - Country:US
Practice Address - Phone:901-759-2020
Practice Address - Fax:901-759-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN160261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment