1932131851 NPI number — DIALYSIS PARTNERS OF NORTHWEST OHIO, LLC

Table of content: (NPI 1932131851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932131851 NPI number — DIALYSIS PARTNERS OF NORTHWEST OHIO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIALYSIS PARTNERS OF NORTHWEST OHIO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932131851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30100 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BINGHAM FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48025-4516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-723-0224
Provider Business Mailing Address Fax Number:
248-642-7852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3310 DUSTIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43616-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-697-2191
Provider Business Practice Location Address Fax Number:
419-697-2177
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPHERD
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
F
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
248-642-5038

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03315 . This is a "PARAMOUNT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 362547 . This is a "STERLING OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6800612 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000327208 . This is a "ANTHEM BC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2141793 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4520152 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 707595 . This is a "FAMILY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000327208 . This is a "BLUE CROSS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 707595 . This is a "BUCKEYE COMM HEALTH" identifier . This identifiers is of the category "OTHER".




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