Provider Demographics
NPI:1043684061
Name:COMMUNITY/ACCESSCARE INDIANA DIALYSIS, LLC
Entity Type:Organization
Organization Name:COMMUNITY/ACCESSCARE INDIANA DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RCHARD
Authorized Official - Last Name:HEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:512-680-0524
Mailing Address - Street 1:8315 E 56TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-1074
Mailing Address - Country:US
Mailing Address - Phone:317-621-3773
Mailing Address - Fax:512-328-0779
Practice Address - Street 1:8315 E 56TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1074
Practice Address - Country:US
Practice Address - Phone:317-621-3773
Practice Address - Fax:512-328-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment