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NPI Code Detail

MEDICARE: DCA OF ROYSTON LLC

MEDICARE: DCA OF ROYSTON 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

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 : 1871556381
Entity Type Code : Organization
Provider Name (Legal Business Name) : DCA OF ROYSTON LLC
Provider Business Mailing Address
First Line : PO BOX 713158
Second Line :
City : CINCINNATI
State : OH
Zip : 45271-3158
Country : US
Telephone Number : 870-931-5400
Fax Number : 870-931-5418
Provider Business Practice Location Address
First Line : 611 COOK ST
Second Line :
City : ROYSTON
State : GA
Zip : 30662-3933
Country : US
Telephone Number : 706-245-0817
Fax Number : 706-245-6450
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 : 10/25/2013

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