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General NPI Number Information
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NPI Number | 1093786105
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Entity Type | Organization
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Legal Business Name | DIALYSIS CENTERS OF OREGON, LLC
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 1360 E POWELL BLVD
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City | GRESHAM
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State | OR
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Zip | 97030-8004
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Country | US
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Telephone | 503-465-1650
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Fax | 503-465-1449
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Provider Business Mailing Address
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Address Line | 1 WORLD TRADE CTR STE 2500
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City | LONG BEACH
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State | CA
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Zip | 90831-0002
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Country | US
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Telephone | 562-495-8075
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Fax | 562-495-8076
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | THOMAS L. WEINBERG
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Credential |
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Telephone | 214-736-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 394019
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License Number State | OR
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