DIALYSIS SERVICES OF PINEVILLE LLC NPI 1811247547

NPI Information

NPI: 1811247547
Provider Name: DIALYSIS SERVICES OF PINEVILLE LLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 18D2049030

Address:
12904 ROBERT L. MADON BYPASS
SUITE 1
PINEVILLE, KY
ZIP 40977
Phone: (606) 337-1110
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DIALYSIS SERVICES OF PINEVILLE LLC is an end-stage renal disease (esrd) treatment clinic center in Pineville, KY. DIALYSIS SERVICES OF PINEVILLE LLC NPI is 1811247547. The provider is registered as an organization entity type.

The provider's business location address is:

12904 ROBERT L. MADON BYPASS
SUITE 1
PINEVILLE, KY
ZIP 40977-063
Phone: (606) 337-1110
Fax: (606) 337-1190

The provider's authorized official is Sara Anne Brady .
The authorized official title is Chief Nursing Officer and has the following contact phone number (208) 371-7878.

The CLIA number assigned to this NPI record is 18D2049030 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/10/2012 and was last updated on 1/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7100240520	MEDICAID	KENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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