HOME DIALYSIS SERVICES OF SANDUSKY INC. NPI 1710910674

NPI Information

NPI: 1710910674
Provider Name: HOME DIALYSIS SERVICES OF SANDUSKY INC.
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 36D2201444

Address:
2819 HAYES AVE
SUITE 2
SANDUSKY, OH
ZIP 44870
Phone: (419) 627-8403
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HOME DIALYSIS SERVICES OF SANDUSKY INC. is an end-stage renal disease (esrd) treatment clinic center in Sandusky, OH. HOME DIALYSIS SERVICES OF SANDUSKY INC. NPI is 1710910674. The provider is registered as an organization entity type.

The provider's business location address is:

2819 HAYES AVE
SUITE 2
SANDUSKY, OH
ZIP 44870-391
Phone: (419) 627-8403
Fax: (419) 627-1962

The provider's authorized official is Gwang Och Kim .
The authorized official title is President and has the following contact phone number (419) 627-0477.

The CLIA number assigned to this NPI record is 36D2201444 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/7/2006 and was last updated on 12/13/2019.

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	000000340065	OTHER	OHIO	ANTHEM
2	2472104	MEDICAID	OHIO

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

NPI Synchronization or Removal

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