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SHELLING DIALYSIS LLC NPI 1356745236


NPI Information

NPI: 1356745236
Provider Name: SHELLING DIALYSIS LLC

Doing Business As: EDGE RIVER DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 03D2089651

Address:
1197 S REDONDO CENTER DR
YUMA, AZ
ZIP 85365
Phone: (928) 329-4340
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SHELLING DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Yuma, AZ. SHELLING DIALYSIS LLC NPI is 1356745236. The provider is registered as an organization entity type.
The provider Is Doing Business As Edge River Dialysis.

The provider's business location address is:

1197 S REDONDO CENTER DR
YUMA, AZ
ZIP 85365-036
Phone: (928) 329-4340
Fax: (928) 783-5018

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 03D2089651 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/21/2014 and was last updated on 2/17/2021.


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) TreatmentYes

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
1087768MEDICAIDARIZONA

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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