POOLER DIALYSIS LLC NPI 1720245152

NPI Information

NPI: 1720245152
Provider Name: POOLER DIALYSIS LLC

Doing Business As: POOLER DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
54 TRADERS WAY
POOLER, GA
ZIP 31322
Phone: (912) 748-1018
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POOLER DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Pooler, GA. POOLER DIALYSIS LLC NPI is 1720245152. The provider is registered as an organization entity type.
The provider Is Doing Business As Pooler Dialysis.

The provider's business location address is:

54 TRADERS WAY
POOLER, GA
ZIP 31322-158
Phone: (912) 748-1018
Fax: (912) 748-4187

The provider's authorized official is Jim K Hilger .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4500.

The CLIA number assigned to this NPI record is 11D1084853 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2008 and was last updated on 10/15/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	ESRD000772	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	112811	MEDICARE OSCAR/CERTIFICATION
2	000619561AH	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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