Provider Demographics
NPI:1932131851
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 1:3310 DUSTIN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3302
Practice Address - Country:US
Practice Address - Phone:419-697-2191
Practice Address - Fax:419-697-2177
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
03315OtherPARAMOUNT
362547OtherSTERLING OPTIONS
6800612OtherUNITED HEALTH CARE
OH000000327208OtherANTHEM BC
OH2141793Medicaid
MI4520152Medicaid
707595OtherFAMILY HEALTH PLAN
000000327208OtherBLUE CROSS OF MICHIGAN
707595OtherBUCKEYE COMM HEALTH
=========003OtherMEDICAL MUTUAL OF OHIO
MI4520152Medicaid
MI4520152Medicaid