Provider Demographics
NPI:1518570886
Name:INDEPENDENT DIALYSIS GROUP NORTHEAST OHIO LLC
Entity Type:Organization
Organization Name:INDEPENDENT DIALYSIS GROUP NORTHEAST OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-781-6212
Mailing Address - Street 1:4822 MARKET ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2122
Mailing Address - Country:US
Mailing Address - Phone:330-781-6212
Mailing Address - Fax:
Practice Address - Street 1:48444 BELL SCHOOL RD STE 4
Practice Address - Street 2:
Practice Address - City:CALCUTTA
Practice Address - State:OH
Practice Address - Zip Code:43920-9646
Practice Address - Country:US
Practice Address - Phone:330-781-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment