RIDGELY DIALYSIS LLC NPI 1497105076

NPI Information

NPI: 1497105076
Provider Name: RIDGELY DIALYSIS LLC

Doing Business As: PORT WARWICK DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 49D2119174

Address:
445 ORIANA RD
STE 18
NEWPORT NEWS, VA
ZIP 23608
Phone: (757) 898-9212
Get Directions

RIDGELY DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Newport News, VA. RIDGELY DIALYSIS LLC NPI is 1497105076. The provider is registered as an organization entity type.
The provider Is Doing Business As Port Warwick Dialysis.

The provider's business location address is:

445 ORIANA RD
STE 18
NEWPORT NEWS, VA
ZIP 23608-742
Phone: (757) 898-9212
Fax: (757) 898-9216

The provider's authorized official is Samuel T Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 49D2119174 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/15/2016 and was last updated on 1/17/2024.

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	1497105076	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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