Provider Demographics
NPI:1376072611
Name:THE DIALYSIS CENTER OF MUNSTER LLC
Entity Type:Organization
Organization Name:THE DIALYSIS CENTER OF MUNSTER LLC
Other - Org Name:MUNSTER DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:10120 CALUMET AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4075
Mailing Address - Country:US
Mailing Address - Phone:219-924-3972
Mailing Address - Fax:219-924-5028
Practice Address - Street 1:10120 CALUMET AVE STE 102
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4075
Practice Address - Country:US
Practice Address - Phone:219-924-3972
Practice Address - Fax:219-924-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment