Provider Demographics
NPI:1649221904
Name:DIALYSIS CENTER OF WABASH VALLEY
Entity Type:Organization
Organization Name:DIALYSIS CENTER OF WABASH VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SISIR
Authorized Official - Middle Name:KHUMAR
Authorized Official - Last Name:DHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-238-1400
Mailing Address - Street 1:615 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2743
Mailing Address - Country:US
Mailing Address - Phone:812-238-1400
Mailing Address - Fax:812-235-7689
Practice Address - Street 1:615 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2743
Practice Address - Country:US
Practice Address - Phone:812-238-1400
Practice Address - Fax:812-235-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
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
IN152532Medicare ID - Type UnspecifiedESRD