MEDICARE: DCA OF CHESAPEAKE 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	22SX	OTHER	MD	CAREFIRST BCBS
2	5001680	OTHER	MD	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477516904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DCA OF CHESAPEAKE LLC

Provider Business Mailing Address
First Line	:	PO BOX 19119
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72403-6601
Country	:	US
Telephone Number	:	870-931-5400
Fax Number	:	870-931-5418

Provider Business Practice Location Address
First Line	:	305 COLLEGE PKWY
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2912
Country	:	US
Telephone Number	:	410-431-5106
Fax Number	:	410-431-5051

Authorized Official
Title or Position	:	VICE PRESIDENT & SECRETARY
Name	:	MR. THOMAS L WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	06/21/2018

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Directions to “DCA OF CHESAPEAKE LLC ” Practice Location

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