OSSIPPEE DIALYSIS LLC NPI 1366924904

NPI Information

NPI: 1366924904
Provider Name: OSSIPPEE DIALYSIS LLC

Doing Business As: MERRIMAC TRAIL DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
469 MERRIMAC TRL
WILLIAMSBURG, VA
ZIP 23185
Phone: (757) 258-3601
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OSSIPPEE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Williamsburg, VA. OSSIPPEE DIALYSIS LLC NPI is 1366924904. The provider is registered as an organization entity type.
The provider Is Doing Business As Merrimac Trail Dialysis.

The provider's business location address is:

469 MERRIMAC TRL
WILLIAMSBURG, VA
ZIP 23185-819
Phone: (757) 258-3601
Fax: (757) 258-3605

The provider's authorized official is Samuel T Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 49D2155719 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/30/2018 and was last updated on 11/29/2023.

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	1366924904	MEDICAID	VIRGINIA

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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