MEDICARE: PARK MERRITT DIALYSIS

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	163WH0500X	Hemodialysis Registered Nurse

General Provider Information

NPI Number	:	1801573639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK MERRITT DIALYSIS

Provider Business Mailing Address
First Line	:	525 E 18TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-2413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E 18TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-2413
Country	:	US
Telephone Number	:	510-914-3916
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHIRLEY S MA
Credential	:
Telephone Number	:	510-914-3916

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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Directions to “PARK MERRITT DIALYSIS ” Practice Location

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