MEDLOCK BRIDGE DIALYSIS LLC (NPI# 1245869619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245869619 |
| Entity Type | Organization |
| Organization Name | MEDLOCK BRIDGE DIALYSIS LLC |
| Other Organization Name | MOUNTAINSIDE DIALYSIS |
| Practice Address |
700 N Main St Jasper GA 30143-1404 |
| Mailing Address |
5200 Virginia Way Brentwood TN 37027-7569 |
| Practice Telephone | 6783871274 |
| Practice Fax Number | 6783871292 |
| Mailing Telephone | 6153204283 |
| Mailing Fax Number | 8003203933 |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2020-09-16 |
| Authorized Official Name | JOHN WINSTEL (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2537334501 |
| Is Organization Subpart | Y |
| Parent Organization Name | DAVITA INC |
| 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 |
|---|---|
| Mountainside Dialysis | Doing Business As Name - Organization |
| Street Address |
700 N MAIN ST |
| City | JASPER |
| State | GA |
| Zip Code | 30143-1404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073111845 | George Mackel, Pmhnp-bc, LLC | Nurse Practitioner | 12034 Big Canoe, 400 Shetland Trace, Jasper, GA 30143 | 2020-10-14 |
| 1598363434 | Amanda J Griggs | Massage Therapist | 54 Wolfscratch Village, Jasper, GA 30143 | 2020-10-13 |
| 1801397724 | Jema Day | Nurse Practitioner | 620 J L White Dr Ste 140, Jasper, GA 30143 | 2018-02-26 |
| 1023467545 | North Georgia Personal Care LLC | Home Health | 501 North Main St., Suite B, Jasper, GA 30143 | 2016-06-06 |
| 1871979641 | Sj & J Spine and Pain Group Holding LLC | Pain Medicine | 91 Sammy Mcghee Blvd, Suite 101, Jasper, GA 30143 | 2015-08-04 |
| 1801294293 | Highland Recovery Center | Community/Behavioral Health | 323 Roland Road, Jasper, GA 30143 | 2014-12-17 |
| 1770905861 | Leslie Rhea Hanagan | Speech-Language Pathologist | 22 Dogwood Lane, Jaser, GA 30143 | 2014-01-09 |
| 1669800660 | Pickens County Chiropractic | Chiropractor | 95 North Main Street, Jasper, GA 30143 | 2013-10-29 |
| 1407139264 | Rocky Mountain Holdings LLC | Ambulance | 70 Airport Business Court, Jasper, GA 30143 | 2011-09-27 |
| 1851681415 | Richard J Vandam | Internal Medicine | 1266 Highway 515, Piedmont Mountainside Hospital, Jasper, GA 30143 | 2011-04-15 |
| Find all providers in zip 30143 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
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|---|---|---|---|---|
| 1134780117 | Fresenius Kidney Care Jasper, LLC | Clinic/Center | 2014 S Wheeler St Ste 300, Jasper, TX 75951-5626 | 2019-06-21 |
| 1376655118 | Nna of Alabama, Inc. | Clinic/Center | 3510 3rd St Ne, Jasper, AL 35504-8200 | 2006-08-31 |
| 1679684567 | Jasper-ara Dialysis L.l.p. | Clinic/Center | 930 Marvin Hancock Dr, Jasper, TX 75951-4752 | 2006-08-31 |
| 1306879796 | Dialysis Clinic Inc. | Clinic/Center | 300 Westfield Pl, Jasper, TN 37347-5142 | 2006-07-08 |
| 1295781268 | Isd Renal Inc | Clinic/Center | 260 6th Ave North, Jasper, AL 35504-0001 | 2006-05-25 |
| 1114983046 | Renal Life Link Inc | Clinic/Center | 671 3rd Ave, Ste A, Jasper, IN 47546-3652 | 2006-04-20 |
| 1801064241 | New Century Dialysis Center of Jasper, L.L.C. | Clinic/Center | 2014 S Wheeler St, Suite 300, Jasper, TX 75951-5624 | 2008-02-19 |
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|---|---|---|---|---|
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| 1336759463 | Plattaz Dialysis, LLC | Clinic/Center | 100 Promenade Pkwy Ste C, Fayetteville, GA 30214-7735 | 2020-08-04 |
| 1174140743 | Home Dialysis Services Norcross LLC | Clinic/Center | 3780 Holcomb Bridge Rd Ste E, Norcross, GA 30092-4877 | 2020-06-30 |
| 1265058275 | Dialysis Care Center Pleasant Hill LLC | Clinic/Center | 1425 Georgia Ave Ste 102, Macon, GA 31201-6546 | 2020-06-25 |
| 1598389132 | Concerto Georgia LLC | Clinic/Center | 655 Exchange Cir Ste 100, Bethlehem, GA 30620-1767 | 2020-05-29 |
| 1629607098 | Rutledge Dialysis, LLC | Clinic/Center | 1719 New Hope Rd, Lawrenceville, GA 30045-6570 | 2020-04-07 |
| 1215562293 | Dialysis Clinic Inc | Clinic/Center | 1219 S. Martin Luther King Blvd., Americuse, GA 31719 | 2020-03-10 |
| 1659915882 | Filmore Dialysis, LLC | Clinic/Center | 4555 Atlanta Hwy Ste M, Loganville, GA 30052-2646 | 2019-10-31 |
| 1013562818 | Menca Dialysis, LLC | Clinic/Center | 3030 Headland Dr Sw Ste C, Atlanta, GA 30311-5435 | 2019-08-08 |
| Find all providers with the same taxonomy | ||||
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| 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.