Healthcare Provider Details

I. General information

NPI: 1841598596
Provider Name (Legal Business Name): DIALYSIS ACCESS SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ORANGE GROVE
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

3004 ORANGE GROVE SUITE 2
CHRISTIANSTED VI
00820-4288
US

V. Phone/Fax

Practice location:
  • Phone: 340-715-7720
  • Fax: 340-713-9002
Mailing address:
  • Phone: 340-715-7720
  • Fax: 340-713-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1675
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1674
License Number StateVI
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number1675
License Number StateVI
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number1674
License Number StateVI

VIII. Authorized Official

Name: DR. TASNIM KHAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 340-715-7720