Provider Demographics
NPI:1467567206
Name:EVEREST HEALTHCARE OHIO, INC.
Entity Type:Organization
Organization Name:EVEREST HEALTHCARE OHIO, INC.
Other - Org Name:DIALYSIS SPECIALISTS OF FAIRFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:4750 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-1848
Mailing Address - Country:US
Mailing Address - Phone:513-863-6882
Mailing Address - Fax:513-863-6898
Practice Address - Street 1:4750 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-1848
Practice Address - Country:US
Practice Address - Phone:513-863-6882
Practice Address - Fax:513-863-6898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2010-12-02
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
362576Medicare Oscar/Certification