Provider Demographics
NPI:1205002854
Name:PHYSICIANS CHOICE DIALYSIS OF CALHOUN COUNTY LLC
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE DIALYSIS OF CALHOUN COUNTY LLC
Other - Org Name:PHYSICIANS CHOICE DIALYSIS OF ANNISTON I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-495-8900
Mailing Address - Street 1:211 COMMERCE COURT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464
Mailing Address - Country:US
Mailing Address - Phone:610-495-8900
Mailing Address - Fax:610-495-8560
Practice Address - Street 1:522 E 11TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4770
Practice Address - Country:US
Practice Address - Phone:256-237-5303
Practice Address - Fax:256-237-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2009-10-02
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
AL013-377OtherBCBS OF ALABAMA
ALDIA2530DMedicaid
AL012530Medicare Oscar/Certification