1982666087 NPI number — ST. THOMAS MORE DIALYSIS CENTER LLC

Table of content: (NPI 1982666087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982666087 NPI number — ST. THOMAS MORE DIALYSIS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. THOMAS MORE DIALYSIS CENTER 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:
Provider Other Organization Name Type Code:
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:
1982666087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4920 LASALLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYATTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20782-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-864-2333
Provider Business Mailing Address Fax Number:
301-864-1377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 LASALLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20782-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-864-2333
Provider Business Practice Location Address Fax Number:
301-864-1377
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NASRAWY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
301-864-2333

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  E2620 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0375251-00 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 408428400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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