Healthcare Provider Details

I. General information

NPI: 1407324247
Provider Name (Legal Business Name): DIALYSIS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 NEWCOMB AVE
MOUNT VERNON KY
40456-2728
US

IV. Provider business mailing address

100 VENTURE CT
LEXINGTON KY
40511-2600
US

V. Phone/Fax

Practice location:
  • Phone: 606-392-4102
  • Fax: 606-392-4103
Mailing address:
  • Phone: 859-252-7712
  • Fax: 859-252-2117

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: WILLIAM E. WOOD II
Title or Position: PRESIDENT
Credential:
Phone: 615-327-3061