Provider Demographics
NPI:1649367988
Name:BELMONT COURT DIALYSIS CENTER INC
Entity type:Organization
Organization Name:BELMONT COURT DIALYSIS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAMGBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-630-1515
Mailing Address - Street 1:2500 BOULEVARD OF THE GENERALS
Mailing Address - Street 2:HAMILTON CAMPUS
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3692
Mailing Address - Country:US
Mailing Address - Phone:610-630-1515
Mailing Address - Fax:610-630-6839
Practice Address - Street 1:2 HAMILTON HEALTH PL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3563
Practice Address - Country:US
Practice Address - Phone:609-689-9260
Practice Address - Fax:609-689-9268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1035958OtherHORIZON MERCY
NJ312552OtherHORIZON BC/BS NEW JERSEY
NJ8344108Medicaid
550788OtherAETNA US HEALTH CARE
0001820000OtherINDEPENDENCE BLUE CROSS
NJ312552Medicare ID - Type Unspecified