Provider Demographics
NPI:1548231467
Name:MEADOW DIALYSIS FACILITY, INC.
Entity Type:Organization
Organization Name:MEADOW DIALYSIS FACILITY, INC.
Other - Org Name:WAYNESBORO DIALYSIS FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-797-2311
Mailing Address - Street 1:12931 OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2914
Mailing Address - Country:US
Mailing Address - Phone:301-797-2311
Mailing Address - Fax:301-733-4025
Practice Address - Street 1:27 VISTA DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2541
Practice Address - Country:US
Practice Address - Phone:717-765-8880
Practice Address - Fax:717-765-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007401790003Medicaid
PA392701Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER