Provider Demographics
NPI:1174817829
Name:DIALYSIS SPECIALISTS OF MARION, INC
Entity type:Organization
Organization Name:DIALYSIS SPECIALISTS OF MARION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBBARAYUDU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-371-5580
Mailing Address - Street 1:125 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6285
Practice Address - Country:US
Practice Address - Phone:740-401-0880
Practice Address - Fax:740-401-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment