Dialysis Clinic Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Browning, MT
NPI 1124043815 · NPPES record last updated Apr 10, 2019
Key facts
- NPI
- 1124043815
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 10379 (MT)
- Legal business name
- DIALYSIS CLINIC INC.
- Practice address
- 760 Hopsital Circle,
Browning, MT 59417 - Phone
- (406) 338-7472
- Fax
- (406) 338-3426
- NPI assigned
- Jul 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. William E. Wood II
- Title
- President
- Phone
- (615) 327-3061
Corporate family (same tax ID) 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Rancho Dialysis Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Dec 24, 2003 Dec 24, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100225000208 | MT | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 4284541129 | Practice locations: Browning, MT |
National Provider Directory
- Tax ID family
- Elbert P Tuttle Jr MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 10379 | MT | Yes |
Addresses
Primary practice location
760 Hopsital Circle,
Browning, MT 59417
Mailing address
2411 Village LN
Billings, MT 59102-2491
Phone (406) 338-7472
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0730065 | Medicaid | MT |
Other providers in Browning, MT
- Amanda Leigh Dean
- Mary K Delong
- Mary Louise Deroche
- Stacia Lee Deshon
- Mary Cecilia Desrosier
- Ellen-Sue Diamant
- Robert Drewelow
- Philip G Driscoll
- Megan Brenna Drury
- Juanita Kay Dubray
All providers in Browning, MT · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.