MACON SOUTHSIDE DIALYSIS CENTER LLC NPI 1073910485

NPI Information

NPI: 1073910485
Provider Name: MACON SOUTHSIDE DIALYSIS CENTER LLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 11D2092466

Address:
2117 EISENHOWER PKWY
MACON, GA
ZIP 31206
Phone: (478) 744-9551
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MACON SOUTHSIDE DIALYSIS CENTER LLC is an end-stage renal disease (esrd) treatment clinic center in Macon, GA. MACON SOUTHSIDE DIALYSIS CENTER LLC NPI is 1073910485. The provider is registered as an organization entity type.

The provider's business location address is:

2117 EISENHOWER PKWY
MACON, GA
ZIP 31206-185
Phone: (478) 744-9551
Fax: (478) 744-9553

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 11D2092466 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/1/2014 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	003159743A	MEDICAID	GEORGIA

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

NPI Synchronization or Removal

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