Provider Demographics
NPI:1801457478
Name:DIALYSIS ACCESS CENTER, LLC
Entity type:Organization
Organization Name:DIALYSIS ACCESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-746-1488
Mailing Address - Street 1:1340 BELMONT AVE STE 2300
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1129
Mailing Address - Country:US
Mailing Address - Phone:330-746-1488
Mailing Address - Fax:330-746-0384
Practice Address - Street 1:8390 TOD AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6366
Practice Address - Country:US
Practice Address - Phone:330-629-2855
Practice Address - Fax:330-629-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical