Provider Demographics
NPI:1023070273
Name:PAUKERT DIALYSIS INC
Entity type:Organization
Organization Name:PAUKERT DIALYSIS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAUKERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN NP
Authorized Official - Phone:707-224-6533
Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE #267
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558
Mailing Address - Country:US
Mailing Address - Phone:707-224-6533
Mailing Address - Fax:707-224-6535
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE #267
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-224-6533
Practice Address - Fax:707-224-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
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
CAZZZ47696ZOtherBLUE SHIELD PROVIDER ID
CA1764OtherPHC
CACDC70009FMedicaid
CA1764OtherPHC
A46651Medicare UPIN