=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417919200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIANS DIALYSIS ACQUISITIONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2006
-----------------------------------------------------
Last Update Date | 06/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 429 MANOR DR STE 650
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931-4917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-472-2642
-----------------------------------------------------
Fax | 814-472-2138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 VIRGINIA WAY L & C DEPT
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-341-6410
-----------------------------------------------------
Fax | 888-662-8259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ACCOUNTING OFFICER
-----------------------------------------------------
Name | JOHN D WINSTEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-733-4501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------