ISD RENAL INC (NPI# 1174579551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174579551 |
| Entity Type | Organization |
| Organization Name | ISD RENAL INC |
| Other Organization Name | LAKE AVENUE DIALYSIS |
| Practice Address |
3909 Lake Ave Fort Wayne IN 46805-5545 |
| Mailing Address |
5200 Virginia Way Licensure & Certification Brentwood TN 37027-7569 |
| Practice Telephone | 2604202666 |
| Practice Fax Number | 2604242036 |
| Mailing Telephone | 6153416374 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2012-07-03 |
| Authorized Official Name | MR. JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2532721916 |
| 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 |
| Other Name | Type Code |
|---|---|
| Lake Avenue Dialysis | Doing Business As Name - Organization |
| 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 |
| 1538793773 | Isd Renal Inc | Clinic/Center | 2317 Memorial Pkwy Sw Ste 105, Huntsville, AL 35801-5623 | 2020-02-26 |
| 1821646035 | Isd Renal Inc | Clinic/Center | 262 Broad St, Newark, NJ 07104-3809 | 2019-08-30 |
| 1245891670 | Isd Renal Inc | Clinic/Center | 100 W Forest Ave Ste G, Englewood, NJ 07631-4033 | 2019-06-26 |
| 1235795204 | Isd Renal Inc | Clinic/Center | 4952 Parkside Ave, Philadelphia, PA 19131 | 2019-05-15 |
| 1003390469 | Isd Renal Inc | Clinic/Center | 1843 Foreman Dr Ste 201, Cookeville, TN 38501-5933 | 2018-09-21 |
| 1174006662 | Isd Renal Inc | Clinic/Center | 2636 W Michigan St, Indianapolis, IN 46222-3727 | 2018-09-11 |
| 1619459682 | Isd Renal Inc | Clinic/Center | 620 Mall Blvd Ste E, Dyersburg, TN 38024-1649 | 2018-09-05 |
| Street Address |
3909 LAKE AVE |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-5545 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| 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 |
|---|---|---|---|---|
| 1558716019 | Duston Dialysis, LLC | Clinic/Center | 415 E Dupont Rd, Fort Wayne, IN 46825-2051 | 2016-05-03 |
| 1659796233 | Randolph Dialysis LLC | Clinic/Center | 6721 Old Trail Rd, Ste 100, Fort Wayne, IN 46809-2655 | 2014-02-19 |
| 1558635276 | Bridges Dialysis LLC | Clinic/Center | 3233 E Coliseum Blvd, Fort Wayne, IN 46805-1561 | 2012-02-27 |
| 1093012544 | Bridges Dialysis LLC | Clinic/Center | 1833 Magnavox Way, Fort Wayne, IN 46804-1539 | 2011-02-18 |
| 1003119876 | Bridges Dialysis LLC | Clinic/Center | 302 E Pettit Ave, Fort Wayne, IN 46806-3007 | 2010-12-16 |
| 1366745630 | Bridges Dialysis LLC | Clinic/Center | 4916 Illinois Rd, Suite 118, Fort Wayne, IN 46804-5116 | 2010-12-08 |
| 1770698524 | Maumee Dialysis Services, LLC | Clinic/Center | 10204 Dupont Circle Dr E, Fort Wayne, IN 46825-1611 | 2006-08-20 |
| 1992751556 | Isd Renal Inc | Clinic/Center | 1940 Bluffton Rd, Fort Wayne, IN 46809-1307 | 2006-05-25 |
| 1639124886 | Dsi Renal Inc | Clinic/Center | 2414 Lake Ave, Fort Wayne, IN 46805-5406 | 2006-05-24 |
| 1386699445 | Isd Renal Inc | Clinic/Center | 7017 S Anthony Blvd, Fort Wayne, IN 46816-2016 | 2006-05-24 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on ISD RENAL INC.
| 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.