Provider Demographics
NPI:1033110036
Name:JOHNSON COUNTY DIALYSIS INC
Entity Type:Organization
Organization Name:JOHNSON COUNTY DIALYSIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-441-5757
Mailing Address - Street 1:10405 W 84TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1641
Mailing Address - Country:US
Mailing Address - Phone:913-492-2044
Mailing Address - Fax:913-492-2451
Practice Address - Street 1:10405 W 84TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1641
Practice Address - Country:US
Practice Address - Phone:913-492-2044
Practice Address - Fax:913-492-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
90237013OtherBC/BS OF KANSAS CITY
17-2501Medicare ID - Type Unspecified