COLLETON DIALYSIS LLC (NPI# 1548697402) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548697402 |
| Entity Type | Organization |
| Organization Name | COLLETON DIALYSIS LLC |
| Other Organization Name | KANSAS AVENUE DIALYSIS |
| Practice Address |
604 Kansas Ave Clinton MO 64735-3069 |
| Mailing Address |
5200 Virginia Way L&c Dept Brentwood TN 37027-7569 |
| Practice Telephone | 6608900830 |
| Practice Fax Number | 6608900789 |
| Mailing Telephone | 6153416264 |
| Mailing Fax Number | 8002972925 |
| Enumeration Date | 2013-10-08 |
| Last Update Date | 2020-06-26 |
| Authorized Official Name | JOHN WINSTEL (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2537334501 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1548697402 | 05 |
| Other Name | Type Code |
|---|---|
| Kansas Avenue Dialysis | Doing Business As Name - Organization |
| Street Address |
604 KANSAS AVE |
| City | CLINTON |
| State | MO |
| Zip Code | 64735-3069 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730543778 | Courtney Briggs | Speech-Language Pathologist | 502 S. 5th, Clinton, MO 64735 | 2016-04-06 |
| 1447669924 | James Taylor Thatcher II | Counselor | 1800 Community Drive, Clinton, MO 64735 | 2014-08-08 |
| 1205271897 | Rocksheng Zhong | Psychiatry & Neurology | 1800 Community Dr, Clinton, MO 64735 | 2013-05-08 |
| 1407196272 | Missouri Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 1501 E Ohio St, Clinton, MO 64735 | 2013-02-15 |
| 1265614176 | Kristal Lynn Moran | Registered Nurse | 1600 N Second St, Clinton, MO 64735 | 2007-12-03 |
| 1174653406 | Gary Allen Groff | Dentist | 1100 E Ohio St, Clinton, MO 64735 | 2007-03-06 |
| 1306908512 | Andrea Jolynn Bruck | Dentist | 906 E Ohio, Clinton, MO 64735 | 2006-12-14 |
| 1992873889 | Golden Valley Memorial Hospital Home Services | Home Health | 1600 North Second Street, Clinton, MO 64735 | 2006-12-01 |
| 1033205521 | Bradley Mark Townsend | Family Medicine | 1413 South Second Street, Clinton, MO 64735 | 2006-10-04 |
| 1871688473 | Michael Jay Harrison | Chiropractor | 704 E. Ohio, Clinton, MO 64735 | 2006-10-03 |
| Find all providers in zip 64735 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770036469 | Bio-medical Applications of Mississippi, Inc. | Clinic/Center | 105 Johnston Pl, Clinton, MS 39056-5911 | 2016-07-28 |
| 1962860288 | Total Renal Care Inc | Clinic/Center | 331 North Blvd, Clinton, NC 28328-1911 | 2016-02-01 |
| 1053705483 | Clinton Dialysis Clinic LLC | Clinic/Center | 103 Ab Jacks Rd, Clinton, SC 29325-2112 | 2015-03-24 |
| 1013344811 | Fresenius Medical Care Surrats, LLC | Clinic/Center | 8949 Woodyard Rd., Clinton, MD 20735-4203 | 2013-10-11 |
| 1760765036 | Bio-medical Applications of Maryland Inc. | Clinic/Center | 8949 Woodyard Road, Clinton, MD 20735-4203 | 2011-09-23 |
| 1588890024 | Rai Care Centers of Clinton LLC | Clinic/Center | 7201 Old Alexandria Ferry Road, Clinton, MD 20735-1865 | 2009-06-10 |
| 1093827800 | Bio-medical Applications of Clinton, Inc. | Clinic/Center | 1740 Southeast Blvd, Clinton, NC 28328-4738 | 2006-08-31 |
| 1093827818 | Rcg University Division, Inc. | Clinic/Center | 317 Professional Park Rd, Clinton, SC 29325-7625 | 2006-08-31 |
| 1770502916 | Dialysis Clinic Inc. | Clinic/Center | 1662 N 2nd St, Clinton, MO 64735-1141 | 2006-07-19 |
| 1730141078 | Renal Treatment Centers West Inc | Clinic/Center | 150 S 31st St, Clinton, OK 73601-9118 | 2006-04-03 |
| Find all providers in CLINTON | ||||
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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.