Big Horn Basin Regional Dialysis Center LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Cody, WY
NPI 1669818969 · NPPES record last updated Jul 15, 2019
Key facts
- NPI
- 1669818969
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- BIG HORN BASIN REGIONAL DIALYSIS CENTER LLC
- Practice address
- 424 Yellowstone Ave
Suite 150
Cody, WY 82414-9309 - Phone
- (307) 578-2223
- Fax
- (307) 578-2217
- NPI assigned
- May 14, 2013
- Organization subpart
- No
Authorized official
- Name
- Mr. William E Wood II
- Title
- President of Member
- Phone
- (615) 327-3061
Member of 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 53D2059939 | Big Horn Basin Regional Dialysis Ctr LLC | Certificate of waiver | Jun 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130710000090 | WY | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 6507006871 | Practice locations: Cody, WY |
National Provider Directory
Locations
424 Yellowstone Ave
Ste 150
Cody, WY 82414
Phone (307) 578-2223
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
424 Yellowstone Ave
Suite 150
Cody, WY 82414-9309
Mailing address
1633 Church St
Suite 500
Nashville, TN 37203-2990
Phone (615) 327-3061
Other providers in Cody, WY
- Big Horn Basin Hearing Inc
- Big Horn Basin Orthopedic Clinic , PC
- Big Horn Basin Pathology
- Big Horn Basin Pathology, PC
- Big Horn Basin Radiology Services LLC
- Big Horn Foot Clinic, PC
- Bighorn Valley Health Center, Incorporated
- Jimmie G Biles Jr.
- Billings Clinic
- Billings Clinic
All providers in Cody, WY · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.