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NPI Code Detail

MEDICARE: PHYSICIANS DIALYSIS COMPANY, INC.

MEDICARE: PHYSICIANS DIALYSIS COMPANY, 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1841306776
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS DIALYSIS COMPANY, INC.
Provider Business Mailing Address
First Line : 9174 MARKET STREET
Second Line :
City : NORTH LIMA
State : OH
Zip : 44452
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9174 MARKET STREET
Second Line :
City : NORTH LIMA
State : OH
Zip : 44452
Country : US
Telephone Number : 330-729-9061
Fax Number :
Authorized Official
Title or Position : TREASURER
Name : MARK FAWCETT
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 08/22/2006
Last Update Date : 12/17/2008

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