Provider Demographics
NPI:1447768601
Name:EAST MONTGOMERY COMMUNITY DIALYSIS LLC
Entity Type:Organization
Organization Name:EAST MONTGOMERY COMMUNITY DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-290-7408
Mailing Address - Street 1:211 COMMERCE CT STE 104
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3483
Mailing Address - Country:US
Mailing Address - Phone:610-495-8900
Mailing Address - Fax:
Practice Address - Street 1:6890 WINTON BLOUNT BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3516
Practice Address - Country:US
Practice Address - Phone:610-495-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment