Provider Demographics
NPI:1760092597
Name:FORT SMITH REGIONAL DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:FORT SMITH REGIONAL DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-755-6750
Mailing Address - Street 1:PO BOX 181210
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72918-1210
Mailing Address - Country:US
Mailing Address - Phone:479-755-6754
Mailing Address - Fax:479-755-6849
Practice Address - Street 1:256 NORTHRIDGE DRIVE E
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956
Practice Address - Country:US
Practice Address - Phone:479-755-6754
Practice Address - Fax:479-755-6849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT SMITH REGIONAL DIALYSIS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment