MEDICARE: DCA OF NORWOOD 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	000000478927	OTHER	OH	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497718993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DCA OF NORWOOD 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	:	1721 TENNESSEE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1201
Country	:	US
Telephone Number	:	513-242-6733
Fax Number	:	513-242-6755

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 NORWOOD LLC ” Practice Location

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