MEDICARE: VACHERIE DIALYSIS CENTER, 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	084	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34655	OTHER	LA	BLUE CROSS BLUE SHIELD LA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659309201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VACHERIE DIALYSIS CENTER, INC.

Provider Business Mailing Address
First Line	:	4424 CONLIN ST
Second Line	:	SUITE 2A
City	:	METAIRIE
State	:	LA
Zip	:	70006-2147
Country	:	US
Telephone Number	:	504-780-1422
Fax Number	:	504-780-1432

Provider Business Practice Location Address
First Line	:	2504 HWY. 20
Second Line	:	SUITE B
City	:	VACHERIE
State	:	LA
Zip	:	70090
Country	:	US
Telephone Number	:	225-265-9030
Fax Number	:	225-265-7070

Authorized Official
Title or Position	:	CEO
Name	:	MR. MURAT HATIPOGLU
Credential	:
Telephone Number	:	504-780-1422

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	10/21/2010

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