Provider Demographics
NPI:1083937494
Name:NORTH CENTRAL PENNSYLVANIA DIALYSIS CLINICS-LEWISBURG LLC
Entity Type:Organization
Organization Name:NORTH CENTRAL PENNSYLVANIA DIALYSIS CLINICS-LEWISBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEDIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:330-781-6212
Mailing Address - Street 1:4822 MARKET ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2122
Mailing Address - Country:US
Mailing Address - Phone:330-781-6212
Mailing Address - Fax:330-953-2041
Practice Address - Street 1:135 JPM RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9313
Practice Address - Country:US
Practice Address - Phone:570-768-4660
Practice Address - Fax:570-768-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2015-03-04
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
PA392763Medicare UPIN