MEDICARE: WYANDOTTE COUNTY DIALYSIS LLC

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	90623019	OTHER		BC/BS OF KANSAS CITY

General Provider Information

NPI Number	:	1518968510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYANDOTTE COUNTY DIALYSIS LLC

Provider Business Mailing Address
First Line	:	10405 W 84TH TER
Second Line	:
City	:	LENEXA
State	:	KS
Zip	:	66214-1641
Country	:	US
Telephone Number	:	913-492-2044
Fax Number	:	913-492-2451

Provider Business Practice Location Address
First Line	:	4837 STATE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-1747
Country	:	US
Telephone Number	:	913-287-2828
Fax Number	:	913-287-8079

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL B LAMBERT
Credential	:	MD
Telephone Number	:	913-441-5757

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/31/2008

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