Provider Demographics
NPI:1487662243
Name:INDEPENDENT DIALYSIS FOUNDATION, INC
Entity Type:Organization
Organization Name:INDEPENDENT DIALYSIS FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INFORMATION SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:ZEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-468-0900
Mailing Address - Street 1:840 HOLLINS ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1024
Mailing Address - Country:US
Mailing Address - Phone:410-468-0900
Mailing Address - Fax:410-468-0911
Practice Address - Street 1:611 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3801
Practice Address - Country:US
Practice Address - Phone:410-468-0900
Practice Address - Fax:410-468-0911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT DIALYSIS FOUNDATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-04
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE2582261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215143OtherMDIPA
MD21506OtherJAI MEDICAL
MD576241-03OtherCAREFIRST
MD0125608OtherAETNA
MD0704865003OtherCIGNA
PA01689292Medicaid
WV0005759000Medicaid
MDPS8OtherFEP
PA01689292Medicaid