BULLOCK DIALYSIS LLC (NPI# 1639715808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639715808 |
| Entity Type | Organization |
| Organization Name | BULLOCK DIALYSIS LLC |
| Other Organization Name | QUEEN CITY DIALYSIS |
| Practice Address |
2290 Ferguson Rd Cincinnati OH 45238 |
| Mailing Address |
5200 Virginia Way Brentwood TN 37027-7569 |
| Practice Telephone | 5133473626 |
| Practice Fax Number | 5133472680 |
| Mailing Telephone | 6153204286 |
| Mailing Fax Number | 8665942893 |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2020-09-08 |
| 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 |
|---|---|
| Queen City Dialysis | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225549942 | Bullock Dialysis LLC | Clinic/Center | 8944 Columbia Rd Ste 6, Loveland, OH 45140-1121 | 2017-10-20 |
| 1477018810 | Bullock Dialysis LLC | Clinic/Center | 1210 Hicks Blvd, Fairfield, OH 45014-1921 | 2019-02-08 |
| 1396200887 | Bullock Dialysis LLC | Clinic/Center | 1532 Main St Ste B, Hamilton, OH 45013-1078 | 2019-02-08 |
| Street Address |
2290 FERGUSON RD |
| City | CINCINNATI |
| State | OH |
| Zip Code | 45238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548860588 | Corey Allison | Case Manager/Care Coordinator | 312 Glenmore Ave. Ste 14, Cincinnati, OH 45238 | 2020-10-29 |
| 1366077174 | Lawanda Antoinette Price | Counselor | 5122 Glenway Crossing Way, Cincinnati, OH 45238 | 2020-03-12 |
| 1629547021 | Abigail M Rebholz | Speech-Language Pathologist | 2039 Anderson Ferry Rd, Cincinnati, OH 45238 | 2018-11-15 |
| 1942667548 | Lashawnda C Gaston | Military Health Care Provider | 1322 Le Mar Dr, Cincinnati, OH 45238 | 2016-01-27 |
| 1134598402 | Abbie Crookham | Registered Nurse | 2146 Ferguson Rd., Cincinnati, OH 45238 | 2015-09-17 |
| 1518341346 | Kenyatta Shena Mccrary | Home Health Aide | 831 Greenwich Ave, Cincinnati, OH 45238 | 2015-07-10 |
| 1225431893 | Brooke Whalen | Dental Assistant | 2146 Ferguson Road, Cincinnati, OH 45238 | 2014-09-26 |
| 1669885588 | Moussa Demba | Medicare Defined Swing Bed Unit | 2484 Queen City Ave Apt 7, Cincinnati, OH 45238 | 2014-06-09 |
| 1811335961 | Kelly G Mirus | Specialist/Technologist | 5161 Ralph Ave, Cincinnati, OH 45238 | 2013-06-11 |
| 1922373596 | Nicholas L. Hoesl | Pharmacist | 5745 Glow Ct., Cincinnati, OH 45238 | 2012-03-15 |
| Find all providers in zip 45238 | ||||
| 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 |
|---|---|---|---|---|
| 1225401649 | Cinld, LLC | Clinic/Center | 1555 Goodman Ave, Cincinnati, OH 45224-1058 | 2015-11-06 |
| 1144611278 | Texoma Dialysis LLC | Clinic/Center | 7700 Affinity Dr, Cincinnati, OH 45231-3566 | 2015-02-11 |
| 1033511092 | Infiniti Dialysis Center of Cincinnati LLC. | Clinic/Center | 4750 E. Galbraith Road, Suite #103, Cincinnati, OH 45236-6706 | 2014-09-22 |
| 1003236357 | Mermet Dialysis LLC | Clinic/Center | 7700 Affinity Pl, Cincinnati, OH 45231-3566 | 2014-04-24 |
| 1427489111 | Nxstage Cincinnati LLC | Clinic/Center | 12065 Montgomery Rd, Cincinnati, OH 45249-1728 | 2013-12-05 |
| 1922314582 | Fields Dialysis LLC | Clinic/Center | 2300 Wall St Ste O, Cincinnati, OH 45212-2789 | 2010-08-20 |
| 1770713026 | Dca of Kenwood LLC | Clinic/Center | 5150 E Galbraith Rd, Cincinnati, OH 45236-2871 | 2009-07-21 |
| 1730321696 | Fields Dialysis LLC | Clinic/Center | 1145 Kemper Meadow Dr, Cincinnati, OH 45240-4118 | 2009-03-24 |
| 1538304399 | Total Renal Care Inc | Clinic/Center | 3960 Red Bank Rd Ste 160, Cincinnati, OH 45227-3421 | 2008-12-09 |
| 1083870406 | 022808 Kenwood LLC | Clinic/Center | 8251 Pine Rd Ste 110, Cincinnati, OH 45236-2193 | 2008-08-05 |
| Find all providers in CINCINNATI | ||||
| City | CINCINNATI |
| Zip Code | 45238 |
Please comment or provide details below to improve the information on BULLOCK DIALYSIS 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.