Provider Demographics
NPI:1659640134
Name:FLINT HILLS DIALYSIS LLC
Entity Type:Organization
Organization Name:FLINT HILLS DIALYSIS LLC
Other - Org Name:FLINT HILLS DIALYSIS OF MARYSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:V
Authorized Official - Last Name:BEDROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-565-9500
Mailing Address - Street 1:1133 COLLEGE AVE
Mailing Address - Street 2:BUILDING B, SUITE 266
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-565-9500
Mailing Address - Fax:785-565-9595
Practice Address - Street 1:708 N 18TH ST
Practice Address - Street 2:SOUTH PLAZA
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1338
Practice Address - Country:US
Practice Address - Phone:785-565-9500
Practice Address - Fax:785-565-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment