Healthcare Provider Details

I. General information

NPI: 1316069701
Provider Name (Legal Business Name): GRAYSON DIALYSIS AND KIDNEY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 13TH AVE
HUNTINGTON WV
25701-3829
US

IV. Provider business mailing address

286 HIGHWAY 1947
GRAYSON KY
41143
US

V. Phone/Fax

Practice location:
  • Phone: 304-529-2090
  • Fax: 304-522-2658
Mailing address:
  • Phone: 606-474-2310
  • Fax: 606-474-0569

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. SUBHASH KUMAR
Title or Position: OWNER MEDICAL DIRECTOR
Credential: MD
Phone: 304-654-8074