NORTHWEST DETROIT DIALYSIS CENTER LLC NPI 1083634471

NPI Information

NPI: 1083634471
Provider Name: NORTHWEST DETROIT DIALYSIS CENTER, LLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 23D0943535

Address:
7800 W OUTER DR
SUITE 190
DETROIT, MI
ZIP 48235
Phone: (313) 270-9239
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NORTHWEST DETROIT DIALYSIS CENTER, LLC is an end-stage renal disease (esrd) treatment clinic center in Detroit, MI. NORTHWEST DETROIT DIALYSIS CENTER, LLC NPI is 1083634471. The provider is registered as an organization entity type.

The provider's business location address is:

7800 W OUTER DR
SUITE 190
DETROIT, MI
ZIP 48235-461
Phone: (313) 270-9239
Fax: (313) 270-9238

The provider's authorized official is David F Shepherd .
The authorized official title is Vice President and has the following contact phone number (248) 642-5038.

The CLIA number assigned to this NPI record is 23D0943535 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/20/2006 and was last updated on 3/4/2015.

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	09457	OTHER		FED BLUE CROSS SECONDARY
2	5066	OTHER		GREATLAKES
3	000000003402	OTHER		CAPE
4	3194098	MEDICAID	MICHIGAN
5	09457	OTHER		BLUE CROSS SECONDARY
6	P09457	OTHER		BLUE CARE NETWORK
7	138129	OTHER		CARE CHOICES
8	138129	OTHER		PREFERRED CHOICE
9	14296	OTHER		M CARE
10	08954	OTHER		BLUE CROSS PRIMARY
11	1008733	OTHER		OMNICARE
12	10078540001	OTHER		WELLNESS
13	232544	MEDICARE OSCAR/CERTIFICATION	MICHIGAN
14	08954	OTHER		FED BLUE CROSS PRIMARY
15	232544	OTHER		HAP

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: 11/14/2023

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