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General NPI Number Information
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NPI Number | 1427207604
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Entity Type | Organization
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Legal Business Name | KIDNEY SERVICES OF WEST CENTRAL OHIO LTD
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 801 PRO DR
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City | CELINA
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State | OH
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Zip | 45822-3307
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Country | US
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Telephone | 419-227-0918
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Fax | 419-227-0873
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Provider Business Mailing Address
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Address Line | 750 W HIGH ST SUITE 100
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City | LIMA
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State | OH
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Zip | 45801-2969
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Country | US
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Telephone | 419-227-0918
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Fax | 419-227-0873
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID L IMLER
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Credential | DO
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Telephone | 419-227-0918
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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 |
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License Number State |
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