Provider Demographics
NPI:1235300377
Name:FAIRVIEW HOSPITAL DIALYSIS CENTER
Entity Type:Organization
Organization Name:FAIRVIEW HOSPITAL DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-447-2000
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01202-1172
Mailing Address - Country:US
Mailing Address - Phone:413-447-2000
Mailing Address - Fax:413-447-2803
Practice Address - Street 1:10 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1904
Practice Address - Country:US
Practice Address - Phone:413-854-9910
Practice Address - Fax:413-854-9911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRVIEW HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2052261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0373OtherMVP
MA1200542Medicaid
MA20850OtherBMC HEALTH NET PLAN
MA900245OtherTUFTS HEALTH PLAN OUTPT
KY221302OtherHUMANA
6300460OtherAETNA
NY10005803OtherCDPHP
MA2222003801OtherBLUE CROSS INPATIENT
MA900038OtherHARVARD PILGRIM
CTHO4359OtherOXFORD HEALTH PLANS
MA905627OtherTUFTS HEALTH PLAN INPT
MA1001728Medicaid
MA12257OtherHEALTH NEW ENGLAND
MA2222003830OtherBLUE CROSS SDC
MA2222003810OtherBLUE CROSS OUTPATIENT
CT992756OtherCONNECTICARE
MA220038OtherUNICARE MA EMPLOYEE GIC
MA220038OtherUNICARE MA EMPLOYEE GIC