Healthcare Provider Details

I. General information

NPI: 1174568885
Provider Name (Legal Business Name): OHIO RIVER DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 YANKEE RD
LIBERTY TOWNSHIP OH
45044-9168
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400 L&C
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 513-423-8098
  • Fax: 513-423-8747
Mailing address:
  • Phone: 615-320-4458
  • Fax: 877-259-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number0811DC
License Number StateOH

VIII. Authorized Official

Name: JAMES K HILGER JR.
Title or Position: CHIEF ACCOUNTING OFFICER
Credential: 2532809501
Phone: 253-382-1919