Provider Demographics
NPI:1295730505
Name:NORTH CENTRAL PENNSYLVANIA DIALYSIS CLINICS LLC
Entity type:Organization
Organization Name:NORTH CENTRAL PENNSYLVANIA DIALYSIS CLINICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMEDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-781-6212
Mailing Address - Street 1:257 S HANNA ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-3644
Mailing Address - Country:US
Mailing Address - Phone:570-748-3800
Mailing Address - Fax:570-748-4650
Practice Address - Street 1:257 S HANNA ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3644
Practice Address - Country:US
Practice Address - Phone:570-748-3800
Practice Address - Fax:570-748-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
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
PA392678Medicare ID - Type Unspecified