MEDICARE: OHIO RIVER DIALYSIS 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	0811DC	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1174568885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO RIVER DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	STE 400 L&C
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4458
Fax Number	:	877-259-3316

Provider Business Practice Location Address
First Line	:	7335 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9168
Country	:	US
Telephone Number	:	513-423-8098
Fax Number	:	513-423-8747

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JAMES K HILGER JR.
Credential	:	2532809501
Telephone Number	:	253-382-1919

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/11/2012

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Directions to “OHIO RIVER DIALYSIS LLC ” Practice Location

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