Provider Demographics
NPI:1720062425
Name:DIALYSIS SERVICES INC
Entity Type:Organization
Organization Name:DIALYSIS SERVICES INC
Other - Org Name:JUPITER KIDNEY CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-744-4661
Mailing Address - Street 1:1000 S OLD DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7207
Mailing Address - Country:US
Mailing Address - Phone:561-744-4661
Mailing Address - Fax:561-743-9846
Practice Address - Street 1:1000 S OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7207
Practice Address - Country:US
Practice Address - Phone:561-744-4661
Practice Address - Fax:561-743-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
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
P11420OtherBEACON
62516OtherVISTA
102451OtherAVMED
0856947OtherSIGNA
6870038OtherUNITED HEATHCARE
V44OtherBCBS, HEALTH OPTIONS
27OtherAMERICA'S HEALTH CHOICE
102527Medicare ID - Type Unspecified