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1720245152 NPI number — POOLER DIALYSIS LLC

NPI Number: 1720245152
Health Care Provider/Practitioner: POOLER DIALYSIS LLC

Information about “1720245152” NPI (POOLER DIALYSIS LLC) exists in 1720245152 in HTML format HTML  |  1720245152 in plain Text format TXT  |  1720245152 in PDF (Portable Document Format) PDF  |  1720245152 in an XML format XML  formats.

NPI Number : 1720245152 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720245152",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "POOLER DIALYSIS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5200 VIRGINIA WAY",
    "SecondLineMailingAddress": "L&C DEPARTMENT",
    "MailingAddressCityName": "BRENTWOOD",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37027-7569",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "615-320-4286",
    "MailingAddressFaxNumber": "866-594-2893",
    "FirstLinePracticeLocationAddress": "54 TRADERS WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POOLER",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31322-4158",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-748-1018",
    "PracticeLocationAddressFaxNumber": "912-748-4187",
    "EnumerationDate": "05/22/2008",
    "LastUpdateDate": "10/15/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HILGER",
    "AuthorizedOfficialFirstName": "JIM",
    "AuthorizedOfficialMiddleName": "K",
    "AuthorizedOfficialTitle": "CHIEF ACCOUNTING OFFICER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "253-733-4500",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QE0700X",
        "TaxonomyName": "End-Stage Renal Disease (ESRD) Treatment Clinic/Center",
        "LicenseNumber": "ESRD000772",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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