Provider Demographics
NPI:1023002391
Name:PENNSYLVANIA DIALYSIS CLINIC OF READING, INC.
Entity Type:Organization
Organization Name:PENNSYLVANIA DIALYSIS CLINIC OF READING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-534-5102
Mailing Address - Street 1:PO BOX 536171
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15253-5903
Mailing Address - Country:US
Mailing Address - Phone:610-375-1215
Mailing Address - Fax:610-375-4753
Practice Address - Street 1:625 SPRING ST
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1770
Practice Address - Country:US
Practice Address - Phone:610-375-1215
Practice Address - Fax:610-375-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011017970003Medicaid
PA392549Medicare Oscar/Certification
392549Medicare ID - Type Unspecified