Provider Demographics
NPI:1548553126
Name:PERITONEAL DIALYSIS CARE CLINIC LLC
Entity type:Organization
Organization Name:PERITONEAL DIALYSIS CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURMEET
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-383-2700
Mailing Address - Street 1:630 W MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2170
Mailing Address - Country:US
Mailing Address - Phone:937-383-2700
Mailing Address - Fax:
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2170
Practice Address - Country:US
Practice Address - Phone:937-383-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091836261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment