Provider Demographics
NPI:1467459271
Name:KIDNEY SERVICES OF WEST CENTRAL OHIO LTD
Entity Type:Organization
Organization Name:KIDNEY SERVICES OF WEST CENTRAL OHIO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DORINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:419-227-0918
Mailing Address - Street 1:601 ST ROUTE 224
Mailing Address - Street 2:PO BOX 100
Mailing Address - City:GLANDORF
Mailing Address - State:OH
Mailing Address - Zip Code:45848
Mailing Address - Country:US
Mailing Address - Phone:419-226-4420
Mailing Address - Fax:419-226-4440
Practice Address - Street 1:601 U S STATE ROUTE 224
Practice Address - Street 2:
Practice Address - City:GLANDORF
Practice Address - State:OH
Practice Address - Zip Code:45848
Practice Address - Country:US
Practice Address - Phone:419-226-4420
Practice Address - Fax:419-226-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0754DC261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2555668Medicaid
OH2555668Medicaid