Provider Demographics
NPI:1679568786
Name:LANER DIALYSIS SUPPLY CO., LLC
Entity Type:Organization
Organization Name:LANER DIALYSIS SUPPLY CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICITAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESPIRITU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-720-5050
Mailing Address - Street 1:24 MACCORKLE AVE SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1476
Mailing Address - Country:US
Mailing Address - Phone:304-720-5050
Mailing Address - Fax:304-720-5050
Practice Address - Street 1:153 CHURCH CAMP RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9261
Practice Address - Country:US
Practice Address - Phone:304-720-5050
Practice Address - Fax:304-720-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0353710-001332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6203010000Medicaid
WV6203010000Medicaid
WV6203010000Medicaid