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NPI Code Detail

MEDICARE: DEDHAM DIALYSIS LLC

MEDICARE: DEDHAM 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1235693458
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEDHAM DIALYSIS LLC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number : 615-341-6410
Fax Number : 888-662-8259
Provider Business Practice Location Address
First Line : 991 PARK AVE
Second Line :
City : MEADVILLE
State : PA
Zip : 16335-3344
Country : US
Telephone Number : 814-336-2531
Fax Number : 814-337-7137
Authorized Official
Title or Position : CHIEF ACCOUNTING OFFICER
Name : JOHN D WINSTEL
Credential :
Telephone Number : 253-733-4501
Provider Enumeration Date : 01/23/2019
Last Update Date : 07/24/2020

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