Provider Demographics
NPI:1740649466
Name:NXKC INDIANAPOLIS NORTHWEST LLC
Entity type:Organization
Organization Name:NXKC INDIANAPOLIS NORTHWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-239-1492
Mailing Address - Street 1:350 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1748
Mailing Address - Country:US
Mailing Address - Phone:978-530-4006
Mailing Address - Fax:978-450-5289
Practice Address - Street 1:9101 WESLEYAN RD
Practice Address - Street 2:SUITE 115
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3166
Practice Address - Country:US
Practice Address - Phone:317-829-9770
Practice Address - Fax:317-876-2530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NXKC INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment