Leesville Dialysis Center, LLC

Primary specialty

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

Legal business name

LEESVILLE DIALYSIS CENTER, LLC

Doing business as

Leesville Dialysis Center

Practice address

900 N 5TH St Ste 5
Leesville, LA 71446-3530

Phone

(337) 392-5122

Fax

(337) 392-1192

NPI assigned

Mar 21, 2007

Last updated

Nov 16, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James J Divito

Title

Vice President

Phone

(781) 699-9000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Leesville Dialysis Center Doing business as

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1497870885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N 5TH ST STE 5",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714463530",
            "telephone_number": "337-392-5122",
            "fax_number": "337-392-1192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N 5TH ST STE 5",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714463530",
            "telephone_number": "337-392-5122",
            "fax_number": "337-392-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEESVILLE DIALYSIS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "DIVITO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "781-699-9000"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1193062",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leesville Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Leesville Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Leesville Heart Center PMC
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• Leesville Surgery Center LLC (Leesville Surgical Center)
• Leesville Urgent Care, LLC
• Lawanda Leftwich-Render

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Leesville, LA
• Providers in Leesville, 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 Nov 16, 2020; 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.