1568617082 NPI number — DIALYSIS SPECIALISTS OF DELAWARE INC

Table of content: (NPI 1568617082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568617082 NPI number — DIALYSIS SPECIALISTS OF DELAWARE INC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
DIALYSIS SPECIALISTS OF DELAWARE 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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1568617082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 S FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELAWARE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43015-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-371-5880
Provider Business Mailing Address Fax Number:
740-362-9251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 S FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAWARE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43015-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-362-9034
Provider Business Practice Location Address Fax Number:
740-362-9251
Provider Enumeration Date:
11/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOPPERA
Authorized Official First Name:
SUBARAYUDU
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-371-5580

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)