| NPI | 1578170221 |
|---|---|
| Doing Business As | PROVIDENT DIALYSIS CENTER |
| Entity Type | Organization |
| Authorized Contact | SCOTT ANDRLE Director Of Managed Care 312-864-4649 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2472R0900X |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2022-03-16 |