Provider Demographics
NPI:1336433556
Name:PHYSICIANS CHOICE DIALYSIS OF UNION SPRINGS LLC
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE DIALYSIS OF UNION SPRINGS LLC
Other - Org Name:PCD UNION SPRINGS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-495-8900
Mailing Address - Street 1:211 COMMERCE CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3483
Mailing Address - Country:US
Mailing Address - Phone:610-495-8900
Mailing Address - Fax:610-495-8560
Practice Address - Street 1:112 CONECUH WEST AVENUE
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-1303
Practice Address - Country:US
Practice Address - Phone:610-495-8900
Practice Address - Fax:610-495-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL013-576OtherBCBS OF AL
AL135143Medicaid
AL013-576OtherBCBS OF AL