BRANBUR DIALYSIS LLC NPI 1043873664

NPI Information

NPI: 1043873664
Provider Name: BRANBUR DIALYSIS LLC

Doing Business As: PUDDLEDOCK DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
4650 PUDDLEDOCK RD
PRINCE GEORGE, VA
ZIP 23875
Phone: (804) 957-5910
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BRANBUR DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Prince George, VA. BRANBUR DIALYSIS LLC NPI is 1043873664. The provider is registered as an organization entity type.
The provider Is Doing Business As Puddledock Dialysis.

The provider's business location address is:

4650 PUDDLEDOCK RD
PRINCE GEORGE, VA
ZIP 23875-235
Phone: (804) 957-5910
Fax: (804) 957-5916

The provider's authorized official is John Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 49D2170164 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/18/2019 and was last updated on 4/25/2023.

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			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	1043873664	MEDICAID	VIRGINIA

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

NPI Synchronization or Removal

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