Southwood Park Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

SOUTHWOOD PARK DIALYSIS LLC

Practice address

17123 Commerce Centre Dr
Prairieville, LA 70769-3481

Phone

(225) 877-2001

Fax

(225) 877-2002

NPI assigned

Jan 11, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John D Winstel

Title

Chief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prairieville Dialysis Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1043676802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-997-4210",
            "fax_number": "866-935-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17123 COMMERCE CENTRE DR",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "707693481",
            "telephone_number": "225-877-2001",
            "fax_number": "225-877-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWOOD PARK DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-11",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2468367",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairieville Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prairieville Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angelica Solano
• Anita S Soule, RDN, LDN
• Leslie Johana Southall
• Southern Psychiatry LLC
• Southerncare, Inc.
• Spectrum Therapy Solutions
• Spectrum Therapy Solutions
• Madison Spinosa
• St. Elizabeth Imaging Center, LLC
• St. Elizabeth Imaging LLC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Prairieville, LA
• Providers in Prairieville, LA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.