Provider Demographics
NPI:1548748718
Name:OUTER BANKS DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:OUTER BANKS DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARLITNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-449-4514
Mailing Address - Street 1:115 EXETER ST
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-9400
Mailing Address - Country:US
Mailing Address - Phone:252-475-3530
Mailing Address - Fax:252-475-3534
Practice Address - Street 1:115 EXETER ST
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9400
Practice Address - Country:US
Practice Address - Phone:252-475-3530
Practice Address - Fax:252-475-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3402598Medicaid