Provider Demographics
NPI:1508948050
Name:WESTERN NEW YORK DC, LLC
Entity Type:Organization
Organization Name:WESTERN NEW YORK DC, LLC
Other - Org Name:GATES CIRCLE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-785-7521
Mailing Address - Street 1:2100 CENTRAL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2838
Mailing Address - Country:US
Mailing Address - Phone:303-785-7523
Mailing Address - Fax:303-444-8639
Practice Address - Street 1:3 GATES CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1120
Practice Address - Country:US
Practice Address - Phone:716-887-4736
Practice Address - Fax:716-887-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401229R261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2VOtherINDEPENDENT HEALTH
NY00030026201OtherUNIVERA INSURANCE COMPANY
NY01984981Medicaid
NE000000378000OtherBLUE CROSS NUMBER
NY00030026201OtherUNIVERA INSURANCE COMPANY