1427207604 NPI number — KIDNEY SERVICES OF WEST CENTRAL OHIO LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427207604 NPI number — KIDNEY SERVICES OF WEST CENTRAL OHIO LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY SERVICES OF WEST CENTRAL OHIO LTD
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:
KIDNEY SERVICES OF WEST CENTRAL OHIO-MERCER COUNTY
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:
1427207604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 W HIGH ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45801-2969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-227-0918
Provider Business Mailing Address Fax Number:
419-227-0873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 PRO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CELINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45822-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-227-0918
Provider Business Practice Location Address Fax Number:
419-227-0873
Provider Enumeration Date:
09/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
IMLER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-227-0918

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