| NPI | 1477664993 |
|---|---|
| Former Legal Business Name | TRAVERSE BAY REGIONAL DIALYSIS CENTER |
| Entity Type | Organization |
| Authorized Contact | MARK S DEPONIO President 231-935-8237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-06-23 |