Provider Demographics
NPI:1386820645
Name:COMMUNITY PHYSICIANS DIALYSIS CENTER-URBANA, LLC.
Entity Type:Organization
Organization Name:COMMUNITY PHYSICIANS DIALYSIS CENTER-URBANA, LLC.
Other - Org Name:CPDC-URBANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPIERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNN
Authorized Official - Phone:937-328-8933
Mailing Address - Street 1:247 S BURNETT RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2639
Mailing Address - Country:US
Mailing Address - Phone:937-328-8921
Mailing Address - Fax:937-525-2466
Practice Address - Street 1:1430 EAST US HWY 36
Practice Address - Street 2:SUITE A
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078
Practice Address - Country:US
Practice Address - Phone:937-328-8933
Practice Address - Fax:937-525-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment