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General NPI Number Information
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NPI Number | 1558485052
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Entity Type | Organization
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Legal Business Name | MOBILE DIALYSIS SOLUTIONS, INC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6488 GLENWAY AVE STE N
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City | CINCINNATI
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State | OH
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Zip | 45211-5223
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Country | US
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Telephone | 513-389-7639
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Fax | 513-389-7633
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Provider Business Mailing Address
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Address Line | 6488 GLENWAY AVE STE N
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City | CINCINNATI
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State | OH
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Zip | 45211-5223
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Country | US
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Telephone | 513-389-7639
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Fax | 513-389-7633
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOSEPH G WAKLATSI
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Credential | RN
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Telephone | 513-389-7639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number | 1617164
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License Number State | OH
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