FREEPORTBAY DIALYSIS LLC


Address: 1808 S West Ave, Freeport, IL 61032-6712
Phone: 8152320295

FREEPORTBAY DIALYSIS LLC (NPI# 1225300056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1225300056
Entity Type Organization
Organization Name FREEPORTBAY DIALYSIS LLC
Other Organization Name DRIFTWOOD DIALYSIS
Practice Address 1808 S West Ave
Freeport
IL 61032-6712
Mailing Address 5200 Virginia Way
L&c Dept
Brentwood
TN 37027-7569
Practice Telephone 8152320295
Practice Fax Number 8152321635
Mailing Telephone 6153204514
Mailing Fax Number 8665949961
Enumeration Date 2012-02-09
Last Update Date 2019-09-04
Authorized Official Name JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
Authorized Official Telephone 2537334500
Is Organization Subpart N

Taxonomy

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 Provider/Organization Names

Other Name Type Code
Driftwood Dialysis Doing Business As Name - Organization

Office Location

Street Address 1808 S WEST AVE
City FREEPORT
State IL
Zip Code 61032-6712

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1245584598 Mary E Brown Massage Therapist 815 W. Pleasant Street, Freeport, IL 61032 2012-11-07
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Taxonomy Information

Taxonomy Code 261QE0700X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization End-Stage Renal Disease (ESRD) Treatment

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
1003445511 Freeport Dialysis LLC Clinic/Center 326 S Brazosport Blvd, Freeport, TX 77541-4540 2020-04-06
1740216159 Huntington Artificial Kidney Center Ltd Clinic/Center 351 S Main St, Freeport, NY 11520-5114 2006-06-25
1568431864 Renal Treatment Centers-illinois Inc Clinic/Center 1028 S Kunkle Blvd, Freeport, IL 61032-6914 2006-03-17
1306203609 Main Street Dialysis Center LLC Clinic/Center 3 N Main St, Freeport, NY 11520-2218 2016-01-19
1265697643 Davita of New York Inc Clinic/Center 267 W Merrick Rd, Freeport, NY 11520-3346 2008-07-24

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1558970525 Concerto Massachusetts LLC Clinic/Center 4600 W Touhy Ave Ste 100, Lincolnwood, IL 60712-1606 2020-07-27
1629697917 East Oaks Dialysis LLC Clinic/Center 2950 W 26th St, Chicago, IL 60623 2020-04-16
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1861026478 Proctor Community Hospital Clinic/Center 5401 N Knoxville Ave Ste 104, Peoria, IL 61614-5021 2020-02-24
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1730725904 Perryton Dialysis LLC Clinic/Center 8604 Woodward Ave, Woodridge, IL 60517-3171 2019-11-22
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Competitor

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City FREEPORT
Zip Code 61032

Improve Information

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Dataset Information

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.

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