Provider Demographics
NPI:1427207604
Name:KIDNEY SERVICES OF WEST CENTRAL OHIO LTD
Entity Type:Organization
Organization Name:KIDNEY SERVICES OF WEST CENTRAL OHIO LTD
Other - Org Name:KIDNEY SERVICES OF WEST CENTRAL OHIO-MERCER COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:IMLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-227-0918
Mailing Address - Street 1:750 W HIGH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2969
Mailing Address - Country:US
Mailing Address - Phone:419-227-0918
Mailing Address - Fax:419-227-0873
Practice Address - Street 1:801 PRO DR
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3307
Practice Address - Country:US
Practice Address - Phone:419-227-0918
Practice Address - Fax:419-227-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2011-04-04
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
OH362737Medicare Oscar/Certification