1952357428 NPI number — COMMUNITY/PHYSICIANS DIALYSIS CENTER, LIMITED

Table of content: (NPI 1952357428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952357428 NPI number — COMMUNITY/PHYSICIANS DIALYSIS CENTER, LIMITED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY/PHYSICIANS DIALYSIS CENTER, LIMITED
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:
CPDC
Provider Other Organization Name Type Code:
5
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:
1952357428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
247 S BURNETT RD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45505-2639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-328-8921
Provider Business Mailing Address Fax Number:
937-525-2466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 N LIMESTONE ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45503-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-930-3125
Provider Business Practice Location Address Fax Number:
937-390-6022
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPIERS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
937-328-8933

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  0465DC , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2073643 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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