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NPI Code Detail

MEDICARE: MIDWEST DIALYSIS CENTER, INC

MEDICARE: MIDWEST DIALYSIS CENTER, INC
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3522573OTHERWIMEDICARE PROVIDER NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083735567
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST DIALYSIS CENTER, INC
Provider Business Mailing Address
First Line : 335 EAST MAHN COURT
Second Line :
City : OAK CREEK
State : WI
Zip : 53154
Country : US
Telephone Number : 414-762-2020
Fax Number : 414-762-2024
Provider Business Practice Location Address
First Line : 3120 S 27TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-4338
Country : US
Telephone Number : 414-672-1006
Fax Number : 414-672-1016
Authorized Official
Title or Position : V.P. OPERATIONS
Name : MR. DAVID A KURZ
Credential :
Telephone Number : 414-762-2020
Provider Enumeration Date : 04/03/2007
Last Update Date : 10/27/2011

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Directions to “MIDWEST DIALYSIS CENTER, INC ” Practice Location

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