WEST IREDELL DIALYSIS CENTER OF WAKE FOREST UNIVERSITY NPI 1124005079

NPI Information

NPI: 1124005079
Provider Name: WEST IREDELL DIALYSIS CENTER OF WAKE FOREST UNIVERSITY

Doing Business As: WEST IREDELL DIALYSIS CENTER

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
115 WESTBROOK LN
STATESVILLE, NC
ZIP 28625
Phone: (704) 881-0336
Get Directions

WEST IREDELL DIALYSIS CENTER OF WAKE FOREST UNIVERSITY is an end-stage renal disease (esrd) treatment clinic center in Statesville, NC. WEST IREDELL DIALYSIS CENTER OF WAKE FOREST UNIVERSITY NPI is 1124005079. The provider is registered as an organization entity type.
The provider Is Doing Business As West Iredell Dialysis Center.

The provider's business location address is:

115 WESTBROOK LN
STATESVILLE, NC
ZIP 28625-349
Phone: (704) 881-0336
Fax: (704) 881-0326

The provider's authorized official is Terry L Hales .
The authorized official title is Assistant Treasurer and has the following contact phone number (336) 716-3003.

The CLIA number assigned to this NPI record is 34D1016848 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/30/2005 and was last updated on 8/15/2023.

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		NORTH CAROLINA	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	3402636	MEDICAID	NORTH CAROLINA
2	001FG	OTHER	NORTH CAROLINA	BCBS-NC

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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