Provider Demographics
NPI:1497017495
Name:DIALYSIS NEWCO INC
Entity Type:Organization
Organization Name:DIALYSIS NEWCO INC
Other - Org Name:DSI WAIPAHU DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-0131
Mailing Address - Street 1:424 CHURCH ST
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2301
Mailing Address - Country:US
Mailing Address - Phone:615-777-8201
Mailing Address - Fax:
Practice Address - Street 1:94-862 KAHUAILANI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3341
Practice Address - Country:US
Practice Address - Phone:808-678-6757
Practice Address - Fax:808-678-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI122525Medicare Oscar/Certification