Healthcare Provider Details

I. General information

NPI: 1578879847
Provider Name (Legal Business Name): DIALYSIS ACCESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JOHN DEERE RD BUILDING 2
MOLINE IL
61265-6898
US

IV. Provider business mailing address

400 JOHN DEERE RD BUILDING 2
MOLINE IL
61265-6898
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-0594
  • Fax: 309-762-5297
Mailing address:
  • Phone: 309-797-0594
  • Fax: 309-762-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJESH ALLA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 309-762-5570