Healthcare Provider Details

I. General information

NPI: 1427207604
Provider Name (Legal Business Name): KIDNEY SERVICES OF WEST CENTRAL OHIO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PRO DR
CELINA OH
45822-3307
US

IV. Provider business mailing address

750 W HIGH ST SUITE 100
LIMA OH
45801-2969
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-0918
  • Fax: 419-227-0873
Mailing address:
  • Phone: 419-227-0918
  • Fax: 419-227-0873

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: DR. DAVID L IMLER
Title or Position: PRESIDENT
Credential: DO
Phone: 419-227-0918