MUNSON DIALYSIS CENTER NPI 1477664993

NPI Information

NPI: 1477664993
Provider Name: MUNSON DIALYSIS CENTER

Former Legal Business Name: TRAVERSE BAY REGIONAL DIALYSIS CENTER

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
4062 W ROYAL DR
TRAVERSE CITY, MI
ZIP 49684
Phone: (231) 935-0447
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MUNSON DIALYSIS CENTER is an end-stage renal disease (esrd) treatment clinic center in Traverse City, MI. MUNSON DIALYSIS CENTER NPI is 1477664993. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Traverse Bay Regional Dialysis Center.

The provider's business location address is:

4062 W ROYAL DR
TRAVERSE CITY, MI
ZIP 49684-965
Phone: (231) 935-0447
Fax: (231) 935-0467

The provider's authorized official is Mark S Deponio .
The authorized official title is President and has the following contact phone number (231) 935-8237.

The enumeration date for this NPI number is 8/31/2006 and was last updated on 6/23/2014.

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	09479	OTHER	MICHIGAN	BCBS SECONDARY DIALYSIS
2	08941	OTHER	MICHIGAN	BCBS DIALYSIS
3	2937976	MEDICAID	MICHIGAN
4	232528	MEDICARE OSCAR/CERTIFICATION	MICHIGAN

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

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