Provider Demographics
NPI:1285850008
Name:BLESSING DIALYSIS CENTER OF PITTSFIELD
Entity Type:Organization
Organization Name:BLESSING DIALYSIS CENTER OF PITTSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENTS
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRERICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-223-8400
Mailing Address - Street 1:640 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1350
Mailing Address - Country:US
Mailing Address - Phone:217-223-8400
Mailing Address - Fax:217-223-9945
Practice Address - Street 1:640 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1350
Practice Address - Country:US
Practice Address - Phone:217-223-8400
Practice Address - Fax:217-223-9945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLESSING HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2021-01-04
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
ILBLUE CROSSOther0123
ILBLUE CROSSOther0123
ILBLUE CROSSOther0123