MEDICARE: KIDNEY CENTER OF WHITEHALL 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

General Provider Information

NPI Number	:	1366809857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY CENTER OF WHITEHALL LLC

Provider Business Mailing Address
First Line	:	6038 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3357
Country	:	US
Telephone Number	:	614-866-4250
Fax Number	:	614-866-4340

Provider Business Practice Location Address
First Line	:	6038 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3357
Country	:	US
Telephone Number	:	614-866-4250
Fax Number	:	614-866-4340

Authorized Official
Title or Position	:	CHIEF NURSING OFFICER
Name	:	SARA ANNE BRADY
Credential	:
Telephone Number	:	208-371-7878

Provider Enumeration Date	:	01/28/2016
Last Update Date	:	01/14/2023

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