Provider Demographics
NPI:1780294702
Name:PREMIER DIALYSIS SERVICE LLC
Entity type:Organization
Organization Name:PREMIER DIALYSIS SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DIPZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-543-6390
Mailing Address - Street 1:1245 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1346
Mailing Address - Country:US
Mailing Address - Phone:888-543-6390
Mailing Address - Fax:
Practice Address - Street 1:1245 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1346
Practice Address - Country:US
Practice Address - Phone:888-543-6390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment