MEDICARE: WSKC DIALYSIS SERVICES, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1205941044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WSKC DIALYSIS SERVICES, INC.

Provider Business Mailing Address
First Line	:	1806 W. HUBBARD ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9998
Country	:	US
Telephone Number	:	312-243-1139
Fax Number	:	312-243-1488

Provider Business Practice Location Address
First Line	:	1806 W. HUBBARD ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-9998
Country	:	US
Telephone Number	:	312-243-1139
Fax Number	:	312-243-1488

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK R FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/17/2016

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