| NPI | 1538527106 |
|---|---|
| Doing Business As | AVERA DIALYSIS WAGNER |
| Entity Type | Organization |
| Authorized Contact | RONALD JOSEPH PLACE President/CEO 605-322-7903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment (Licence: SD 10563) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2023-10-04 |