Provider Demographics
NPI:1588808661
Name:KIDNEY CENTER AT MILLVILLE LLC
Entity Type:Organization
Organization Name:KIDNEY CENTER AT MILLVILLE LLC
Other - Org Name:KIDNEY CENTER AT MILLVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-575-4777
Mailing Address - Street 1:1318 S MAIN RD
Mailing Address - Street 2:BLDG 3
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6516
Mailing Address - Country:US
Mailing Address - Phone:856-692-1600
Mailing Address - Fax:856-692-1615
Practice Address - Street 1:3 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332
Practice Address - Country:US
Practice Address - Phone:856-692-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment