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ITASCA DIALYSIS LLC NPI 1699288092


NPI Information

NPI: 1699288092
Provider Name: ITASCA DIALYSIS LLC

Doing Business As: BRIGHTON PARK DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
4737 S CALIFORNIA AVE
CHICAGO, IL
ZIP 60632
Phone: (773) 523-2441
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ITASCA DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Chicago, IL. ITASCA DIALYSIS LLC NPI is 1699288092. The provider is registered as an organization entity type.
The provider Is Doing Business As Brighton Park Dialysis.

The provider's business location address is:

4737 S CALIFORNIA AVE
CHICAGO, IL
ZIP 60632-015
Phone: (773) 523-2441
Fax: (773) 523-2468

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 enumeration date for this NPI number is 11/8/2017 and was last updated on 10/25/2021.


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

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: 11/14/2023

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