1063763274 NPI number — DSI CONYERS, LLC

Table of content: (NPI 1063763274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063763274 NPI number — DSI CONYERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DSI CONYERS, 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:
U.S. RENAL CARE CONYERS DIALYSIS
Provider Other Organization Name Type Code:
3
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:
1063763274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 CHURCH STREET
Provider Second Line Business Mailing Address:
SUITE 1900
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37219-2387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-777-8200
Provider Business Mailing Address Fax Number:
615-234-9526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1927 HIGHWAY 138 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30013-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-483-6124
Provider Business Practice Location Address Fax Number:
770-929-9091
Provider Enumeration Date:
09/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
214-736-2700

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)





Copyright © 2007-2024 www.npivalidator.com