Provider Demographics
NPI:1841598596
Name:DIALYSIS ACCESS SPECIALISTS, LLC
Entity Type:Organization
Organization Name:DIALYSIS ACCESS SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TASNIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-715-7720
Mailing Address - Street 1:3004 ORANGE GROVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4288
Mailing Address - Country:US
Mailing Address - Phone:340-715-7720
Mailing Address - Fax:340-713-9002
Practice Address - Street 1:5 ORANGE GROVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-715-7720
Practice Address - Fax:340-713-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1675207R00000X, 207RN0300X
VI1674207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1674OtherVIRGIN ISLANDS DEPARTMENT OF HEALTH
VI1675OtherVI DEPARTMENT OF HEALTH
VI1841598596Medicaid