Provider Demographics
NPI:1750382610
Name:GSH DIALYSIS, INC.
Entity type:Organization
Organization Name:GSH DIALYSIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUDGET/REIMBURSEMENT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:717-270-7811
Mailing Address - Street 1:440 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6243
Mailing Address - Country:US
Mailing Address - Phone:717-274-7552
Mailing Address - Fax:717-272-3061
Practice Address - Street 1:440 OAK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6243
Practice Address - Country:US
Practice Address - Phone:717-274-7552
Practice Address - Fax:717-272-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA392557261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011692470001Medicaid
PA1601OtherHIGHMARK BLUE SHIELD
PA392557OtherCAIC
PA392557Medicare ID - Type Unspecified