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1114290475 NPI number — JOLIET DIALYSIS HOLDINGS, LLC

NPI Number: 1114290475
Health Care Provider/Practitioner: JOLIET DIALYSIS HOLDINGS, LLC

Information about “1114290475” NPI (JOLIET DIALYSIS HOLDINGS, LLC) exists in 1114290475 in HTML format HTML  |  1114290475 in plain Text format TXT  |  1114290475 in PDF (Portable Document Format) PDF  |  1114290475 in an XML format XML  formats.

NPI Number : 1114290475 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114290475",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JOLIET DIALYSIS HOLDINGS, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "368 S. WEBER ROAD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROMEOVILLE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60446",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "815-254-0283",
    "MailingAddressFaxNumber": "815-254-1397",
    "FirstLinePracticeLocationAddress": "368 S. WEBER ROAD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROMEOVILLE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60446",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-254-0283",
    "PracticeLocationAddressFaxNumber": "815-254-1397",
    "EnumerationDate": "02/17/2012",
    "LastUpdateDate": "04/15/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MAJKA-KRAVETS",
    "AuthorizedOfficialFirstName": "ZDZISLAWA",
    "AuthorizedOfficialMiddleName": "TERESA",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "815-245-2466",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RN0300X",
          "TaxonomyName": "Nephrology Physician",
          "LicenseNumber": "042.005614",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QE0700X",
          "TaxonomyName": "End-Stage Renal Disease (ESRD) Treatment Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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