1528341070 NPI number — DIALYSIS NEWCO LLC

Table of content: (NPI 1528341070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528341070 NPI number — DIALYSIS NEWCO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIALYSIS NEWCO 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 MESA 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:
1528341070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 CHURCH ST
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:
37219-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-234-1188
Provider Business Mailing Address Fax Number:
615-234-9526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1337 S GILBERT RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85204-6073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-926-1906
Provider Business Practice Location Address Fax Number:
480-926-1909
Provider Enumeration Date:
09/21/2011

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 , with the licence number:  OTC3996 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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