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NPI Code Detail

MEDICARE: PHYSICIANS DIALYSIS COMPANY INC.

MEDICARE: PHYSICIANS DIALYSIS COMPANY 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

General Provider Information

NPI Number : 1396849170
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS DIALYSIS COMPANY INC.
Provider Business Mailing Address
First Line : 2425 GARDEN WAY
Second Line : SUITE 102
City : HERMITAGE
State : PA
Zip : 16148-5215
Country : US
Telephone Number : 724-347-0700
Fax Number : 724-347-0900
Provider Business Practice Location Address
First Line : 2425 GARDEN WAY
Second Line : SUITE 102
City : HERMITAGE
State : PA
Zip : 16148-5215
Country : US
Telephone Number : 724-347-0700
Fax Number : 724-347-0900
Authorized Official
Title or Position : TREASURER
Name : MARK R FAWCETT
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 09/12/2006
Last Update Date : 11/16/2011

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Directions to “PHYSICIANS DIALYSIS COMPANY INC. ” Practice Location

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