Provider Demographics
NPI:1770546244
Name:MY DIALYSIS, LLC
Entity type:Organization
Organization Name:MY DIALYSIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:RYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-404-2331
Mailing Address - Street 1:7600 AFFINITY PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3535
Mailing Address - Country:US
Mailing Address - Phone:513-931-7900
Mailing Address - Fax:513-931-0400
Practice Address - Street 1:7600 AFFINITY PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3535
Practice Address - Country:US
Practice Address - Phone:513-931-7900
Practice Address - Fax:513-931-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2024-05-28
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
OH000000329554OtherANTHEM
OH2405196Medicaid
OH=========002OtherMEDICAL MUTUAL
OH2405196Medicaid