MEDICARE: PURITY DIALYSIS CENTERS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52D1091140	OTHER	WI	CLIA ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669650545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURITY DIALYSIS CENTERS INC

Provider Business Mailing Address
First Line	:	2301 SUN VALLEY DR STE 200
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2318
Country	:	US
Telephone Number	:	262-646-6426
Fax Number	:	262-646-2498

Provider Business Practice Location Address
First Line	:	2301 SUN VALLEY DR STE 101
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2318
Country	:	US
Telephone Number	:	262-646-6426
Fax Number	:	262-646-2498

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MS. TINA M WALDRON
Credential	:
Telephone Number	:	262-646-6426

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	10/28/2016

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Directions to “PURITY DIALYSIS CENTERS INC ” Practice Location

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