MEDICARE: DIXON DIALYSIS CENTER, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50306	OTHER	IL	BCBS OF IL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457350563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIXON DIALYSIS CENTER, LLC

Provider Business Mailing Address
First Line	:	400 JOHN DEERE RD
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-6898
Country	:	US
Telephone Number	:	309-762-5570
Fax Number	:	309-762-5297

Provider Business Practice Location Address
First Line	:	101 W 2ND ST
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3076
Country	:	US
Telephone Number	:	815-284-0555
Fax Number	:	815-284-0580

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RAJESH ALLA
Credential	:	M.D.
Telephone Number	:	309-762-5570

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/29/2014

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Directions to “DIXON DIALYSIS CENTER, LLC ” Practice Location

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