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NPI Code Detail

MEDICARE: MOSES DIALYSIS UNIT

MEDICARE: MOSES DIALYSIS UNIT
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/Center495001MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629155304
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOSES DIALYSIS UNIT
Provider Business Mailing Address
First Line : 220 BURDETTE ST
Second Line :
City : SAINT IGNACE
State : MI
Zip : 49781-1712
Country : US
Telephone Number : 906-643-0408
Fax Number : 906-643-7821
Provider Business Practice Location Address
First Line : 220 BURDETTE ST
Second Line :
City : SAINT IGNACE
State : MI
Zip : 49781-1712
Country : US
Telephone Number : 906-643-0408
Fax Number : 906-643-7821
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : RODNEY NELSON
Credential :
Telephone Number : 906-643-0455
Provider Enumeration Date : 11/01/2006
Last Update Date : 08/22/2020

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Directions to “MOSES DIALYSIS UNIT ” Practice Location

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