Provider Demographics
NPI:1942350830
Name:DIALYSIS SERVICES OF BELPRE, INC
Entity Type:Organization
Organization Name:DIALYSIS SERVICES OF BELPRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUBBARAYUDU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-401-0880
Mailing Address - Street 1:809 FARSON AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1066
Mailing Address - Country:US
Mailing Address - Phone:740-401-0880
Mailing Address - Fax:740-401-0885
Practice Address - Street 1:809 FARSON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1066
Practice Address - Country:US
Practice Address - Phone:740-401-0880
Practice Address - Fax:740-401-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0533051Medicaid
OH0533051Medicaid