PURE LIFE RENAL OF LANSDOWNE, LLC (NPI# 1013457720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013457720 |
| Entity Type | Organization |
| Organization Name | PURE LIFE RENAL OF LANSDOWNE, LLC |
| Practice Address |
19490 Sandridge Way Suite 140 Leesburg VA 20176-3465 |
| Mailing Address |
4000 Hollywood Blvd Suite 300-n Hollywood FL 33021-6751 |
| Practice Telephone | 9549625733 |
| Mailing Telephone | 2162640284 |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |
| Authorized Official Name | MR. JEFF FERNANDEZ (CFO) |
| Authorized Official Telephone | 9549625733 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| Street Address |
19490 SANDRIDGE WAY SUITE 140 |
| City | LEESBURG |
| State | VA |
| Zip Code | 20176-3465 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790836690 | Jack Pete Ayoub | Obstetrics & Gynecology | 19490 Sandridge Way, 350, Leesburg, VA 20176 | 2007-01-16 |
| 1578002275 | Loudoun Medical Group, P.C. | Specialist | 19490 Sandridge Way, Suite 120, Leesburg, VA 20176-3465 | 2017-02-15 |
| 1588025027 | Loudoun Medical Group PC | Psychiatry & Neurology | 19490 Sandridge Way, Suite 260, Leesburg, VA 20176-3465 | 2016-03-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053912923 | Timothy Michael Nixon | Pharmacist | 61 Catoctin Circle, Leesburg, VA 20176 | 2020-11-05 |
| 1558996645 | Stacey E Moran | Occupational Therapist | 44124 Woodrige Parkway, Lansdowne, VA 20176 | 2020-03-09 |
| 1710531272 | Joseph H Kasuska Jr. | Specialist/Technologist | 19455 Deerfield Ave. Suite 306, Lansdowne, VA 20176 | 2019-08-01 |
| 1568935849 | Joel Manalang Polintan Jr. | Physical Therapist | 171 Cedarwalk Circle, Leesburg, VA 20176 | 2019-01-09 |
| 1194203026 | Jing Cao | Acupuncturist | 19450 Deerfield Ave Ste 275, Leesburg, VA 20176 | 2018-08-02 |
| 1134648314 | Alaina Marie Gotwalt | Speech-Language Pathologist | 43850 Heatherstone Terrace, Unit 406, Leesburg, VA 20176 | 2017-09-19 |
| 1841717105 | Happy Inhome Care Corp | Respite Care | 722 E Market St Ste 103, Leesburg, VA 20176 | 2017-08-28 |
| 1912423484 | Aaa Good Healthcare LLC | Nursing Care | 722 East Market Street Ne, Suite 102, Leesburg, VA 20176 | 2017-08-16 |
| 1740704253 | Anna Maria Domingo Seaford | Physician Assistant | 19441 Golf Vista Plz Ste 230, Lansdowne, VA 20176 | 2017-07-27 |
| 1710436480 | Reena Patel | Physician Assistant | 224 Cornwall St Nw Leesburg Orthope, Unit 204, Leesburg, VA 20176 | 2016-09-23 |
| Find all providers in zip 20176 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
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|---|---|---|---|---|
| 1447889399 | Legacy Dialysis of Virginia | Clinic/Center | 211 Gibson St Nw Ste 209, Leesburg, VA 20176-2115 | 2020-04-03 |
| 1851744247 | Dialysis Care Center Leesburg LLC | Clinic/Center | 600 W North Blvd Ste B, Leesburg, FL 34748-5000 | 2016-07-20 |
| 1205872173 | Total Renal Care Inc | Clinic/Center | 401 E North Blvd, Leesburg, FL 34748-5262 | 2006-06-21 |
| 1982671004 | Renal Treatment Centers Southeast Lp | Clinic/Center | 8425 Us Highway 441, Ste 104, Leesburg, FL 34788-4038 | 2006-03-07 |
| 1588108104 | Dialysis Clinic Inc | Clinic/Center | 210 Park St, Leesburg, GA 31763-5192 | 2016-12-16 |
| 1295078277 | Total Renal Care Inc | Clinic/Center | 44084 Riverside Pkwy, Suite 100, Leesburg, VA 20176-5102 | 2013-03-28 |
| 1538470653 | Total Renal Care Inc | Clinic/Center | 224d Cornwall St Nw, Ste 100, Leesburg, VA 20176-2700 | 2010-06-23 |
| 1669631297 | Canyonlands Dialysis LLC | Clinic/Center | 224 Cornwall St Nw, Leesburg, VA 20176-2701 | 2008-06-09 |
| 1962479386 | Renal Treatment Centers Southeast Lp | Clinic/Center | 211 N 1st St, Leesburg, FL 34748-5150 | 2006-03-03 |
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| 1760004360 | Renal Treatment Centers - Mid-atlantic, Inc. | Clinic/Center | 7525 Tidewater Dr Ste 37, Norfolk, VA 23505-3700 | 2020-05-18 |
| 1871113746 | Renal Treatment Centers - Mid-atlantic, Inc. | Clinic/Center | 165 Market St Ste 6, Onancock, VA 23417-4233 | 2020-04-21 |
| 1457907917 | Renal Treatment Centers - Mid-atlantic, Inc. | Clinic/Center | 570 Westgate Shopping Ctr, Bedford, VA 24523-2643 | 2019-08-12 |
| 1306492848 | Renal Treatment Centers- Mid-atlantic, Inc. | Clinic/Center | 145 Holt Garrison Pkwy Ste 340, Danville, VA 24540-5956 | 2019-08-12 |
| 1043873664 | Branbur Dialysis LLC | Clinic/Center | 4650 Puddledock Rd, Prince George, VA 23875-1235 | 2019-04-18 |
| 1811454226 | Mohansic Dialysis, LLC | Clinic/Center | 8123 Richmond Hwy, Alexandria, VA 22309-3613 | 2019-02-22 |
| 1720552110 | Shawano Dialysis, LLC | Clinic/Center | 13859 Village Place Dr, Midlothian, VA 23114-3503 | 2019-01-18 |
| 1528533171 | Gansett Dialysis, LLC | Clinic/Center | 8605 Westwood Center Dr Ste 100, Vienna, VA 22182-2231 | 2018-10-10 |
| 1518449784 | Renal Treatment Centers - Mid-atlantic Inc | Clinic/Center | 19980 Highland Vista Dr Ste 100, Ashburn, VA 20147-4189 | 2018-09-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.