Provider Demographics
NPI: | 1982183224 |
---|---|
Name: | RENAL TREATMENT CENTERS MID ATLANTIC INC |
Entity Type: | Organization |
Organization Name: | RENAL TREATMENT CENTERS MID ATLANTIC INC |
Other - Org Name: | AVONWORTH DIALYSIS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CAO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HILGER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 310-536-2400 |
Mailing Address - Street 1: | 5200 VIRGINIA WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | BRENTWOOD |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37027-7569 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-320-4283 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 251 MOUNT NEBO POINTE RD |
Practice Address - Street 2: | |
Practice Address - City: | PITTSBURGH |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15237-1313 |
Practice Address - Country: | US |
Practice Address - Phone: | 412-364-3238 |
Practice Address - Fax: | 412-364-0523 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-08-08 |
Last Update Date: | 2019-11-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QE0700X | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |