Healthcare Provider Details

I. General information

NPI: 1588808661
Provider Name (Legal Business Name): KIDNEY CENTER AT MILLVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ELIZABETH AVE
MILLVILLE NJ
08332
US

IV. Provider business mailing address

1318 S MAIN RD BLDG 3
VINELAND NJ
08360-6516
US

V. Phone/Fax

Practice location:
  • Phone: 856-692-1600
  • Fax:
Mailing address:
  • Phone: 856-692-1600
  • Fax: 856-692-1615

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. JAMES T O'CONNELL
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 856-575-4777