Provider Demographics
NPI:1356362941
Name:NEPHRON DIALYSIS CENTER LTD
Entity type:Organization
Organization Name:NEPHRON DIALYSIS CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOCALIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-293-2100
Mailing Address - Street 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-293-2100
Mailing Address - Fax:773-293-2101
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-293-2100
Practice Address - Fax:773-293-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2015-09-09
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
IL2135OtherBLUECROSS BLUESHIELD
IL2135OtherBLUECROSS BLUESHIELD
IL142600Medicare Oscar/Certification