NORTHEAST PHILADELPHIA DIALYSIS CENTER LLC (NPI# 1093229809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093229809 |
| Entity Type | Organization |
| Organization Name | NORTHEAST PHILADELPHIA DIALYSIS CENTER LLC |
| Practice Address |
9815 Roosevelt Blvd Ste 1-a Philadelphia PA 19114-1035 |
| Practice Telephone | 2153300494 |
| Practice Fax Number | 2153300495 |
| Mailing Telephone | 2153300494 |
| Mailing Fax Number | 2153300495 |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2020-03-17 |
| Authorized Official Name | SHARI K COUSINS (SR. VP OF CLINICAL & REGULATORY) |
| Authorized Official Telephone | 9789223080 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| Street Address |
9815 ROOSEVELT BLVD STE 1-A |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19114-1035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029906 | Phuoc Nguyen | Nurse Anesthetist, Certified Registered | Jefferson Torresdale Hospital, 10800 Knights Rd, Philadelphia, PA 19114 | 2020-10-05 |
| 1053921932 | Priyanka Patel | Dentist | Philadelphia Dental Smiles, 9140 Academy Road, Philadelphia, PA 19114 | 2020-08-05 |
| 1215419080 | Thomas Patrick Gallagher | Specialist/Technologist | 2708 Ruth Way, Philadelphia, PA 19114 | 2018-08-29 |
| 1558840223 | Alexis Wenger | Early Intervention Provider Agency | 3810 Aubrey Ave, Phila, PA 19114 | 2018-08-13 |
| 1245759232 | Newlands Health | Clinic/Center | 9625 Frankford Ave., Philadelphia, PA 19114 | 2017-09-12 |
| 1619491453 | Nazareth Physician Services Inc | Social Worker | 9815 Roosevelt Blvd Ste G, Philadelphia, PA 19114 | 2017-08-02 |
| 1326561606 | L.s. Share & Love Support Coordinating Agency, LLC | Case Management | 3600 Red Lion Road, Apt 68c, Philadelphia, PA 19114 | 2017-07-19 |
| 1760911952 | Charles C Richards II | Counselor | 2555 Welsh Rd, Apt 407, Philadelphia, PA 19114 | 2017-06-09 |
| 1801338686 | April Neuls | Physical Therapy Assistant | 4213 Lackland Place, Philadelphia, PA 19114 | 2016-11-10 |
| 1114317583 | Siji Cyriac | Physical Therapist | 9501 State Road, Philadelphia, PA 19114 | 2015-01-23 |
| Find all providers in zip 19114 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295344307 | Isd Renal Inc | Clinic/Center | 1930 S Broad St Unit 7, Philadelphia, PA 19145-2328 | 2020-07-24 |
| 1225647332 | Isd Renal Inc | Clinic/Center | 230 N Broad St Bldg 12th, Philadelphia, PA 19102-1121 | 2020-07-24 |
| 1336758549 | Isd Renal Inc | Clinic/Center | 1300 W Lehigh Ave Ste 106, Philadelphia, PA 19132-2764 | 2020-07-24 |
| 1235795204 | Isd Renal Inc | Clinic/Center | 4952 Parkside Ave, Philadelphia, PA 19131 | 2019-05-15 |
| 1306322516 | Isd Renal, Inc | Clinic/Center | 6501 Roosevelt Blvd, Ste 6581, Philadelphia, PA 19149-2918 | 2018-07-11 |
| 1134640949 | Isd Renal Inc | Clinic/Center | 1236 N 26th St, Philadelphia, PA 19121-4602 | 2017-06-30 |
| 1851812069 | Total Renal Care Inc | Clinic/Center | 235 W Chelten Ave, Philadelphia, PA 19144-3802 | 2017-06-28 |
| 1710411707 | Rcg Mississippi, Inc. | Clinic/Center | 1100 Central Drive, Philadelphia, MS 39350 | 2017-04-17 |
| 1609249986 | Bio-medical Applications of Pennsylvania, Inc. | Clinic/Center | 301 W Chelten Ave, Philadelphia, PA 19144-3804 | 2015-11-09 |
| 1184091142 | The Dialysis Center of West Philadelphia LLC | Clinic/Center | 4800 Brown St Ste 201, Philadelphia, PA 19139-2106 | 2015-08-26 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19114 |
Please comment or provide details below to improve the information on NORTHEAST PHILADELPHIA DIALYSIS CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.