Provider Demographics
NPI:1831214204
Name:RICHARDSON DIALYSIS, LLC
Entity type:Organization
Organization Name:RICHARDSON DIALYSIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:230 HIGHWAY 3048
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-3624
Mailing Address - Country:US
Mailing Address - Phone:318-728-9801
Mailing Address - Fax:318-728-9804
Practice Address - Street 1:230 HIGHWAY 3048
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3624
Practice Address - Country:US
Practice Address - Phone:318-728-9801
Practice Address - Fax:318-728-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-07-20
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
LA1505595Medicaid
LA19-2677Medicare ID - Type Unspecified