Provider Demographics
NPI:1336161066
Name:APOLLO HEALTHCARE LLC
Entity Type:Organization
Organization Name:APOLLO HEALTHCARE LLC
Other - Org Name:NIAGARA RENAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-282-2200
Mailing Address - Street 1:3018 MILITARY ROAD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304
Mailing Address - Country:US
Mailing Address - Phone:716-298-4195
Mailing Address - Fax:716-298-5964
Practice Address - Street 1:3018 MILITARY ROAD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304
Practice Address - Country:US
Practice Address - Phone:716-298-4195
Practice Address - Fax:716-298-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3102205R261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
358002OtherBLUE CROSS BLUE SHIELD
00011419902OtherUNIVERA HEALTHCARE
NY02394076Medicaid
P7OtherINDEPENDENT HEALTH
358002OtherBLUE CROSS BLUE SHIELD