Provider Demographics
NPI:1073600391
Name:BELMONT COURT DIALYSIS CENTER INC
Entity Type:Organization
Organization Name:BELMONT COURT DIALYSIS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAMGBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-630-1515
Mailing Address - Street 1:2500 BOULEVARD OF THE GENERALS
Mailing Address - Street 2:ROOSEVELT
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3692
Mailing Address - Country:US
Mailing Address - Phone:610-630-1515
Mailing Address - Fax:610-630-6839
Practice Address - Street 1:6593 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2918
Practice Address - Country:US
Practice Address - Phone:215-537-6000
Practice Address - Fax:215-537-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA08380OtherHEALTH/SENIOR PARTNERS
PAX000260701OtherAMERICHOICE
PA0000427000OtherINDEPENDENCE BLUE CROSS
PA1007285120013Medicaid
PA50745OtherAETNA US HEALTH CARE
PAPPA06037OtherSTATE RENAL
PA1021750OtherKEYSTONE MERCY
PA392618Medicare ID - Type Unspecified