1629461470 NPI number — BABLER DIALYSIS, LLC

Table of content: (NPI 1629461470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629461470 NPI number — BABLER DIALYSIS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BABLER DIALYSIS, 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:
ROCHESTER 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:
1629461470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 VIRGINIA WAY
Provider Second Line Business Mailing Address:
ATT: L&C DEPARTMENT
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-320-4514
Provider Business Mailing Address Fax Number:
866-594-9961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2660 S BROADWAY
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55904-6263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-288-1617
Provider Business Practice Location Address Fax Number:
507-289-0672
Provider Enumeration Date:
03/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WEY
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SR DIRECTOR LICENSURE&CERTIFICATION
Authorized Official Telephone Number:
615-341-6641

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)

  • Identifier: 1629461470 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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