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NPI Code Detail

MEDICARE: ST. THOMAS MORE DIALYSIS CENTER LLC

MEDICARE: ST. THOMAS MORE DIALYSIS CENTER 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/CenterE2620MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982666087
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. THOMAS MORE DIALYSIS CENTER LLC
Provider Business Mailing Address
First Line : 4920 LASALLE RD
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20782-3302
Country : US
Telephone Number : 301-864-2333
Fax Number : 301-864-1377
Provider Business Practice Location Address
First Line : 4920 LASALLE RD
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20782-3302
Country : US
Telephone Number : 301-864-2333
Fax Number : 301-864-1377
Authorized Official
Title or Position : CFO
Name : MR. JOSEPH NASRAWY
Credential :
Telephone Number : 301-864-2333
Provider Enumeration Date : 04/04/2006
Last Update Date : 02/13/2009

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Directions to “ST. THOMAS MORE DIALYSIS CENTER LLC ” Practice Location

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