Provider Demographics
NPI:1790074516
Name:LDFS LLC
Entity Type:Organization
Organization Name:LDFS LLC
Other - Org Name:U.S. RENAL CARE FLAGSTAFF DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:424 CHURCH ST
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2301
Mailing Address - Country:US
Mailing Address - Phone:615-777-8201
Mailing Address - Fax:
Practice Address - Street 1:2268 N WALGREENS ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-6101
Practice Address - Country:US
Practice Address - Phone:928-556-5500
Practice Address - Fax:928-556-5501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-01
Last Update Date:2016-03-29
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
AZ815589Medicaid
AZ032636Medicare Oscar/Certification