CANYONLANDS DIALYSIS LLC NPI 1669631297

NPI Information

NPI: 1669631297
Provider Name: CANYONLANDS DIALYSIS LLC

Doing Business As: LEESBURG VIRGINIA DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
224 CORNWALL ST NW
LEESBURG, VA
ZIP 20176
Phone: (571) 258-1362
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CANYONLANDS DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Leesburg, VA. CANYONLANDS DIALYSIS LLC NPI is 1669631297. The provider is registered as an organization entity type.
The provider Is Doing Business As Leesburg Virginia Dialysis.

The provider's business location address is:

224 CORNWALL ST NW
LEESBURG, VA
ZIP 20176-701
Phone: (571) 258-1362
Fax: (571) 258-1342

The provider's authorized official is Jim Hilger .
The authorized official title is Vice President and has the following contact phone number (253) 382-1919.

The CLIA number assigned to this NPI record is 49D1087986 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/9/2008 and was last updated on 11/25/2008.

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	492654	MEDICARE OSCAR/CERTIFICATION
2	1669631297	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

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