Provider Demographics
NPI:1760424964
Name:DIALYSIS SERVICES OF GAYLORD, INC
Entity Type:Organization
Organization Name:DIALYSIS SERVICES OF GAYLORD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:CURRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-466-3272
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-0548
Mailing Address - Country:US
Mailing Address - Phone:989-466-3395
Mailing Address - Fax:989-466-7454
Practice Address - Street 1:1989 WALDEN DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8241
Practice Address - Country:US
Practice Address - Phone:989-731-6418
Practice Address - Fax:989-731-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2007-10-22
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
MI09485OtherBCBSM
MI08970OtherBCBSM
MI232556Medicare ID - Type Unspecified