Provider Demographics
NPI:1760500144
Name:MOREHOUSE PARISH DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:MOREHOUSE PARISH DIALYSIS CENTER, LLC
Other - Org Name:MOREHOUSE PARISH DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-323-8847
Mailing Address - Street 1:530 DURHAM ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5013
Mailing Address - Country:US
Mailing Address - Phone:318-281-3725
Mailing Address - Fax:318-281-3727
Practice Address - Street 1:530 DURHAM ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5013
Practice Address - Country:US
Practice Address - Phone:318-281-3725
Practice Address - Fax:318-281-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-08-07
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
192676Medicare Oscar/Certification