MEDICARE: INDEPENDENT DIALYSIS SERVICES, INC

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30345	OTHER	LA	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1811980626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT DIALYSIS SERVICES, INC

Provider Business Mailing Address
First Line	:	2900 ELYSIAN FIELDS AVE
Second Line	:	SUITE B
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-3625
Country	:	US
Telephone Number	:	504-947-3625
Fax Number	:	504-947-3675

Provider Business Practice Location Address
First Line	:	2900 ELYSIAN FIELDS AVE
Second Line	:	SUITE B
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-3625
Country	:	US
Telephone Number	:	504-947-3625
Fax Number	:	504-947-3675

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHERANCE TAYLOR
Credential	:
Telephone Number	:	504-914-3625

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	08/22/2020

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