MEDICARE: RENAL FOCUS ASC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1003575218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAL FOCUS ASC LLC

Provider Business Mailing Address
First Line	:	PO BOX 411230
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-1230
Country	:	US
Telephone Number	:	610-644-8900
Fax Number	:	484-924-0053

Provider Business Practice Location Address
First Line	:	671 OLD COUNTRY RD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4910
Country	:	US
Telephone Number	:	516-898-7299
Fax Number	:	516-898-7301

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	GREGG MILLER
Credential	:	MD
Telephone Number	:	717-515-4048

Provider Enumeration Date	:	12/15/2021
Last Update Date	:	12/09/2025

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