Provider Demographics
NPI:1376895045
Name:DIALYSIS SERVICES OF LONDON LLC
Entity Type:Organization
Organization Name:DIALYSIS SERVICES OF LONDON LLC
Other - Org Name:
Other - Org Type:
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 1:306 SOUTH PLZ
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2645
Mailing Address - Country:US
Mailing Address - Phone:606-862-0110
Mailing Address - Fax:606-862-0210
Practice Address - Street 1:306 SOUTH PLZ
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2645
Practice Address - Country:US
Practice Address - Phone:606-862-0110
Practice Address - Fax:606-862-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2023-01-10
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
KY7100264080Medicaid
KY182621Medicare Oscar/Certification