TYLER DIALYSIS LLC NPI 1760732408

NPI Information

NPI: 1760732408
Provider Name: TYLER DIALYSIS LLC
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Doing Business As: LOURDES MT LAUREL DIALYSIS
CLIA Number: 31D2007444
Address: 130 GAITHER DR
STE 172
MOUNT LAUREL, NJ
ZIP 08054
Phone: (856) 222-4195

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NPI Details

TYLER DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Mount Laurel, NJ. TYLER DIALYSIS LLC NPI is 1760732408. The provider is registered as an organization entity type.
The provider Is Doing Business As Lourdes Mt Laurel Dialysis.

The provider's business location address is:

130 GAITHER DR
STE 172
MOUNT LAUREL, NJ
ZIP 08054-715
Phone: (856) 222-4195
Fax: (856) 235-4842

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 31D2007444 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/10/2012 and was last updated on 7/6/2020.

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	22204	NEW JERSEY	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	0318191	MEDICAID	NEW JERSEY

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: 3/30/2025

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