Provider Demographics
NPI:1073713301
Name:NEPHROLOGY ASSOCIATES AT OAKWOOD
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES AT OAKWOOD
Other - Org Name:CENTER FOR DIALYSIS CARE, OAKWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINTERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-295-7003
Mailing Address - Street 1:18720 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4855
Mailing Address - Country:US
Mailing Address - Phone:216-295-7003
Mailing Address - Fax:216-295-7014
Practice Address - Street 1:7690 FIRST PL
Practice Address - Street 2:BUILDING 'D', SUITE 'F'
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-6700
Practice Address - Country:US
Practice Address - Phone:216-295-7003
Practice Address - Fax:216-295-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2015-06-17
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
OH2843276Medicaid
OH2843276Medicaid