MEDICARE: WESTERN NEW YORK DC, 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	1401229R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000378002	OTHER	NY	BLUE CROSS PROVIDER NUMBE
3	2V	OTHER	NY	INDEPENDENT HEALTH

General Provider Information

NPI Number	:	1598830218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN NEW YORK DC, LLC

Provider Business Mailing Address
First Line	:	2100 CENTRAL AVE
Second Line	:	SUITE 201
City	:	BOULDER
State	:	CO
Zip	:	80301-2838
Country	:	US
Telephone Number	:	303-785-7523
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 TAYLOR RD
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-2232
Country	:	US
Telephone Number	:	716-209-7200
Fax Number	:	716-209-7206

Authorized Official
Title or Position	:	CFO
Name	:	HERBERT S LAWSON
Credential	:
Telephone Number	:	303-785-7521

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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