Healthcare Provider Details

I. General information

NPI: 1710368063
Provider Name (Legal Business Name): HOME DIALYSIS SERVICES KANSAS CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 W 121ST ST STE 100
OVERLAND PARK KS
66209-2042
US

IV. Provider business mailing address

PO BOX 3134
JOLIET IL
60434-3134
US

V. Phone/Fax

Practice location:
  • Phone: 913-283-8063
  • Fax: 913-283-8854
Mailing address:
  • Phone: 815-741-6830
  • Fax: 815-741-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MORUFU ALAUSA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 815-741-6830