MIDWEST LEGACY CAPITAL LLC NPI 1972008704

NPI Information

NPI: 1972008704
Provider Name: MIDWEST LEGACY CAPITAL LLC

Doing Business As: AT HOME KIDNEYCARE

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
W4233 STATE RD 54
BLACK CREEK, WI
ZIP 54106
Phone: (920) 915-5202
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MIDWEST LEGACY CAPITAL LLC is an end-stage renal disease (esrd) treatment clinic center in Black Creek, WI. MIDWEST LEGACY CAPITAL LLC NPI is 1972008704. The provider is registered as an organization entity type.
The provider Is Doing Business As At Home Kidneycare.

The provider's business location address is:

W4233 STATE RD 54
BLACK CREEK, WI
ZIP 54106-633
Phone: (920) 915-5202

The provider's authorized official is Thomas A Dudley .
The authorized official title is Ceo and has the following contact phone number (920) 915-5202.

The enumeration date for this NPI number is 3/26/2018 and was last updated on 3/26/2018.

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

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

NPI Synchronization or Removal

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