Provider Demographics
NPI:1093968471
Name:KIDNEY CENTER OF CLEVELAND, LLC
Entity Type:Organization
Organization Name:KIDNEY CENTER OF CLEVELAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-648-4900
Mailing Address - Street 1:2253 CHAMBLISS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311
Mailing Address - Country:US
Mailing Address - Phone:423-648-4900
Mailing Address - Fax:423-648-1868
Practice Address - Street 1:2253 CHAMBLISS AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-648-4900
Practice Address - Fax:423-648-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment