Provider Demographics
NPI:1992284814
Name:COMMUNITY MEDICAL CENTER DIALYSIS
Entity type:Organization
Organization Name:COMMUNITY MEDICAL CENTER DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:615-327-3061
Mailing Address - Street 1:135 COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1900
Mailing Address - Country:US
Mailing Address - Phone:406-756-5565
Mailing Address - Fax:406-756-7712
Practice Address - Street 1:1325 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4759
Practice Address - Country:US
Practice Address - Phone:406-728-6585
Practice Address - Fax:406-728-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment