Provider Demographics
NPI:1982647608
Name:RENAL CENTER OF ATHENS, LLLP
Entity Type:Organization
Organization Name:RENAL CENTER OF ATHENS, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3033-834-4000
Mailing Address - Street 1:14062 DENVER WEST PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3187
Mailing Address - Country:US
Mailing Address - Phone:303-384-4000
Mailing Address - Fax:303-273-5991
Practice Address - Street 1:212 CAYUGA DRIVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751
Practice Address - Country:US
Practice Address - Phone:903-677-9587
Practice Address - Fax:903-677-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007973261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452818Medicare ID - Type Unspecified