1528066818 NPI number — NEPHROLOGY NURSING SERVICE INC.

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 1528066818 NPI number — NEPHROLOGY NURSING SERVICE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY NURSING SERVICE INC.
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:
GIRARD DIALYSIS CENTER
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:
1528066818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8TH ST. & GIRARD AVENUE
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-787-2278
Provider Business Mailing Address Fax Number:
215-787-2171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8TH ST. AT GIRARD AVE.
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-787-2278
Provider Business Practice Location Address Fax Number:
215-787-2171
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
215-787-2278

Provider Taxonomy Codes

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

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

  • Identifier: 0014611740002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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