1639150907 NPI number — DIALYSIS CENTERS OF DAYTON, LLC

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 1639150907 NPI number — DIALYSIS CENTERS OF DAYTON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIALYSIS CENTERS OF DAYTON, 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:
1639150907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 S. LUDLOW ST.
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-499-8850
Provider Business Mailing Address Fax Number:
937-223-9615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 TURNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45415-3630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-499-8850
Provider Business Practice Location Address Fax Number:
937-223-9615
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
JAYME
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
937-499-8850

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: 6800128 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000065135 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2178665 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39544 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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