Provider Demographics
NPI:1659374247
Name:DIAMOND DIALYSIS INC.
Entity Type:Organization
Organization Name:DIAMOND DIALYSIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-238-5200
Mailing Address - Street 1:9415 S WESTERN AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-6232
Mailing Address - Country:US
Mailing Address - Phone:773-238-5200
Mailing Address - Fax:773-238-5527
Practice Address - Street 1:9415 S WESTERN AVE
Practice Address - Street 2:STE 105
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-6232
Practice Address - Country:US
Practice Address - Phone:773-238-5200
Practice Address - Fax:773-238-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
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
IL1633535OtherBLUE CROSS BLUE SHIELD
IL1633535OtherBLUE CROSS BLUE SHIELD
IL1633535OtherBLUE CROSS BLUE SHIELD