Provider Demographics
NPI:1659309201
Name:VACHERIE DIALYSIS CENTER, INC.
Entity Type:Organization
Organization Name:VACHERIE DIALYSIS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MURAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HATIPOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-780-1422
Mailing Address - Street 1:4424 CONLIN ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2147
Mailing Address - Country:US
Mailing Address - Phone:504-780-1422
Mailing Address - Fax:504-780-1432
Practice Address - Street 1:2504 HWY. 20
Practice Address - Street 2:SUITE B
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090
Practice Address - Country:US
Practice Address - Phone:225-265-9030
Practice Address - Fax:225-265-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA084261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA34655OtherBLUE CROSS BLUE SHIELD LA
LA1681407Medicaid
LA34655OtherBLUE CROSS BLUE SHIELD LA