Healthcare Provider Details

I. General information

NPI: 1538404132
Provider Name (Legal Business Name): KUMAR DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CAVALIER BLVD
FLORENCE KY
41042-3969
US

IV. Provider business mailing address

749 SHIVEL LN
HUNTINGTON WV
25705-3842
US

V. Phone/Fax

Practice location:
  • Phone: 304-529-2090
  • Fax:
Mailing address:
  • Phone: 304-654-8074
  • Fax:

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 State

VIII. Authorized Official

Name: MR. SUBHASH KUMAR
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 304-654-8074