Provider Demographics
NPI:1205826435
Name:DANVILLE DIALYSIS SERVICES, LLC
Entity Type:Organization
Organization Name:DANVILLE DIALYSIS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIJNANDAN
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SODHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-446-1111
Mailing Address - Street 1:910 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4309
Mailing Address - Country:US
Mailing Address - Phone:217-446-1111
Mailing Address - Fax:217-446-1115
Practice Address - Street 1:910 W CLAY ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4309
Practice Address - Country:US
Practice Address - Phone:217-446-1111
Practice Address - Fax:217-446-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049900261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid
ILC44989Medicare UPIN