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TYLER DIALYSIS LLC NPI 1891044756


NPI Information

NPI: 1891044756
Provider Name: TYLER DIALYSIS LLC

Doing Business As: LOURDES CAMDEN DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 31D2007788

Address:
1601 HADDON AVE
CAMDEN, NJ
ZIP 08103
Phone: (856) 541-0647
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TYLER DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Camden, NJ. TYLER DIALYSIS LLC NPI is 1891044756. The provider is registered as an organization entity type.
The provider Is Doing Business As Lourdes Camden Dialysis.

The provider's business location address is:

1601 HADDON AVE
CAMDEN, NJ
ZIP 08103-109
Phone: (856) 541-0647
Fax: (856) 541-2698

The provider's authorized official is John Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 31D2007788 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/6/2012 and was last updated on 1/11/2023.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment24696NEW JERSEYYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10335991MEDICAIDNEW JERSEY

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: 4/28/2024

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