Provider Demographics
NPI:1336824135
Name:AMERICAN ACADEMY OF DIALYSIS-VASCULAR SPECIALISTS
Entity Type:Organization
Organization Name:AMERICAN ACADEMY OF DIALYSIS-VASCULAR SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CCO
Authorized Official - Prefix:
Authorized Official - First Name:PEACHES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:317-627-2377
Mailing Address - Street 1:3701 DORVAL PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-6774
Mailing Address - Country:US
Mailing Address - Phone:317-627-2377
Mailing Address - Fax:
Practice Address - Street 1:1611 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1903
Practice Address - Country:US
Practice Address - Phone:317-627-2377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Multi-Specialty