Provider Demographics
NPI:1891910865
Name:KUMAR DIALYSIS LLC
Entity Type:Organization
Organization Name:KUMAR DIALYSIS LLC
Other - Org Name:LOUISA FORT GAY REGIONAL DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-654-8074
Mailing Address - Street 1:1656 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3829
Mailing Address - Country:US
Mailing Address - Phone:304-529-2062
Mailing Address - Fax:304-522-2658
Practice Address - Street 1:2145 HIGHWAY 2565
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9166
Practice Address - Country:US
Practice Address - Phone:606-638-3403
Practice Address - Fax:606-638-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-06-18
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
KY000000494344OtherANTHEM BCBS PROVIDER NUMB
WV3810006539Medicaid
KY7100007940Medicaid
KY182580OtherMEDICARE PART A
1164474425OtherS. KUMAR INDIVIDUAL NPI
KY182580OtherMEDICARE PART A