Provider Demographics
NPI:1063971562
Name:CAMBRIDGE DIALYSIS GROUP LLC
Entity type:Organization
Organization Name:CAMBRIDGE DIALYSIS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-669-8237
Mailing Address - Street 1:9396 E PURDUE AVE UNIT 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-9105
Mailing Address - Country:US
Mailing Address - Phone:856-669-8238
Mailing Address - Fax:
Practice Address - Street 1:9396 E PURDUE AVE UNIT 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-9105
Practice Address - Country:US
Practice Address - Phone:856-669-8238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No335U00000XSuppliersOrgan Procurement Organization