Healthcare Provider Details

I. General information

NPI: 1801457478
Provider Name (Legal Business Name): DIALYSIS ACCESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8390 TOD AVE STE 2
BOARDMAN OH
44512-6366
US

IV. Provider business mailing address

1340 BELMONT AVE STE 2300
YOUNGSTOWN OH
44504-1129
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-2855
  • Fax: 330-629-2855
Mailing address:
  • Phone: 330-746-1488
  • Fax: 330-746-0384

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. NATHANIEL S DOE
Title or Position: PRESIDENT
Credential: MD
Phone: 330-746-1488