SOUTHEASTERN RENAL DIALYSIS L.C. NPI 1497711386

NPI Information

NPI: 1497711386
Provider Name: SOUTHEASTERN RENAL DIALYSIS L.C.
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
507 S WHITE ST
MT PLEASANT, IA
ZIP 52641
Phone: (319) 385-6720
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SOUTHEASTERN RENAL DIALYSIS L.C. is an end-stage renal disease (esrd) treatment clinic center in Mt Pleasant, IA. SOUTHEASTERN RENAL DIALYSIS L.C. NPI is 1497711386. The provider is registered as an organization entity type.

The provider's business location address is:

507 S WHITE ST
MT PLEASANT, IA
ZIP 52641-625
Phone: (319) 385-6720
Fax: (319) 385-6726

The provider's authorized official is Mary Liechty .
The authorized official title is Administrator and has the following contact phone number (319) 385-6728.

The enumeration date for this NPI number is 4/21/2006 and was last updated on 3/16/2012.

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		IOWA	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	0625095	MEDICAID	IOWA
2	162509	MEDICARE OSCAR/CERTIFICATION	IOWA

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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