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NPI Code Detail

MEDICARE: PAUKERT DIALYSIS INC

MEDICARE: PAUKERT DIALYSIS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ47696ZOTHERCABLUE SHIELD PROVIDER ID
21764OTHERCAPHC
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023070273
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAUKERT DIALYSIS INC
Provider Business Mailing Address
First Line : 1100 TRANCAS ST
Second Line : SUITE #267
City : NAPA
State : CA
Zip : 94558
Country : US
Telephone Number : 707-224-6533
Fax Number : 707-224-6535
Provider Business Practice Location Address
First Line : 1100 TRANCAS ST
Second Line : SUITE #267
City : NAPA
State : CA
Zip : 94558
Country : US
Telephone Number : 707-224-6533
Fax Number : 707-224-6535
Authorized Official
Title or Position : OWNER ADMINISTRATOR
Name : MRS. SHERYLE E PAUKERT
Credential : RN NP
Telephone Number : 707-224-6533
Provider Enumeration Date : 04/04/2006
Last Update Date : 08/22/2020

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Directions to “PAUKERT DIALYSIS INC ” Practice Location

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