ELLICOTT KIDNEY CENTER LLC NPI 1255754677

NPI Information

NPI: 1255754677
Provider Name: ELLICOTT KIDNEY CENTER LLC
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Address: 3000 N RIDGE RD
SUITE A
ELLICOTT CITY, MD
ZIP 21043
Phone: (410) 465-0273

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NPI Details

ELLICOTT KIDNEY CENTER LLC is an end-stage renal disease (esrd) treatment clinic center in Ellicott City, MD. ELLICOTT KIDNEY CENTER LLC NPI is 1255754677. The provider is registered as an organization entity type.

The provider's business location address is:

3000 N RIDGE RD
SUITE A
ELLICOTT CITY, MD
ZIP 21043-311
Phone: (410) 465-0273
Fax: (410) 465-0360

The provider's authorized official is Jason Boucher .
The authorized official title is Cfo and has the following contact phone number (978) 922-3080.

The enumeration date for this NPI number is 1/22/2014 and was last updated on 3/21/2019.

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	422934700	MEDICAID	MARYLAND

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: 11/21/2025

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