Provider Demographics
NPI:1396849170
Name:PHYSICIANS DIALYSIS COMPANY INC.
Entity Type:Organization
Organization Name:PHYSICIANS DIALYSIS COMPANY INC.
Other - Org Name:RENAL CARE GROUP HERMITAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:2425 GARDEN WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5215
Mailing Address - Country:US
Mailing Address - Phone:724-347-0700
Mailing Address - Fax:724-347-0900
Practice Address - Street 1:2425 GARDEN WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5215
Practice Address - Country:US
Practice Address - Phone:724-347-0700
Practice Address - Fax:724-347-0900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2011-11-16
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
PA392546Medicare Oscar/Certification