Healthcare Provider Details

I. General information

NPI: 1558485052
Provider Name (Legal Business Name): MOBILE DIALYSIS SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6488 GLENWAY AVE STE N
CINCINNATI OH
45211-5223
US

IV. Provider business mailing address

6488 GLENWAY AVE STE N
CINCINNATI OH
45211-5223
US

V. Phone/Fax

Practice location:
  • Phone: 513-389-7639
  • Fax: 513-389-7633
Mailing address:
  • Phone: 513-389-7639
  • Fax: 513-389-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number1617164
License Number StateOH

VIII. Authorized Official

Name: MR. JOSEPH G WAKLATSI
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 513-389-7639