Provider Demographics
NPI:1740213677
Name:DIALYSIS PARTNERS OF NORTHWEST OHIO, LLC
Entity Type:Organization
Organization Name:DIALYSIS PARTNERS OF NORTHWEST OHIO, LLC
Other - Org Name:DIALYSIS PARTNERS OF NORTHWEST OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-642-5038
Mailing Address - Street 1:30100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4516
Mailing Address - Country:US
Mailing Address - Phone:248-723-0224
Mailing Address - Fax:248-642-7852
Practice Address - Street 1:3401 GLENDALE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2418
Practice Address - Country:US
Practice Address - Phone:419-389-9681
Practice Address - Fax:419-389-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-05-27
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
707595OtherFAMILY HEALTH PLAN
362509OtherSTERLING OPTIONS
MI4520152Medicaid
OH2168701Medicaid
6800612OtherUNITED HEALTH CARE
707595OtherBUCKEYE COMM HEALTH
OH000000327208OtherANTHEM BC
03315OtherPARAMOUNT
000000327208OtherBLUE CROSS OF MICHIGAN
000000327208OtherBLUE CROSS OF MICHIGAN
6800612OtherUNITED HEALTH CARE
OH2168701Medicaid