MEDICARE: GRAYSON DIALYSIS AND KIDNEY CENTER

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000494978	OTHER	KY	ANTHEM BCBS PROV NUMBER

General Provider Information

NPI Number	:	1316069701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAYSON DIALYSIS AND KIDNEY CENTER

Provider Business Mailing Address
First Line	:	286 HIGHWAY 1947
Second Line	:
City	:	GRAYSON
State	:	KY
Zip	:	41143
Country	:	US
Telephone Number	:	606-474-2310
Fax Number	:	606-474-0569

Provider Business Practice Location Address
First Line	:	1656 13TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3829
Country	:	US
Telephone Number	:	304-529-2090
Fax Number	:	304-522-2658

Authorized Official
Title or Position	:	OWNER MEDICAL DIRECTOR
Name	:	DR. SUBHASH KUMAR
Credential	:	MD
Telephone Number	:	304-654-8074

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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