Healthcare Provider Details

I. General information

NPI: 1992776132
Provider Name (Legal Business Name): DIALYSIS CENTERS OF NORTHWEST OHIO, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ENTERPRISE ST
FREMONT OH
43420-8550
US

IV. Provider business mailing address

PO BOX 19119
JONESBORO AR
72403-6601
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-9104
  • Fax: 419-332-9105
Mailing address:
  • Phone: 870-931-5400
  • Fax: 870-931-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number0634DC
License Number StateOH

VIII. Authorized Official

Name: THOMAS L. WEINBERG
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 214-736-2700