SOUTH FORK DIALYSIS LLC (NPI# 1659647808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659647808 |
| Entity Type | Organization |
| Organization Name | SOUTH FORK DIALYSIS LLC |
| Other Organization Name | HERNDON DIALYSIS |
| Practice Address |
560 E Herndon Ave Ste 101 Fresno CA 93720-2907 |
| Mailing Address |
5200 Virginia Way L&c Dept Brentwood TN 37027-7569 |
| Practice Telephone | 5594325278 |
| Practice Fax Number | 5594351422 |
| Mailing Telephone | 6153416765 |
| Mailing Fax Number | 8337829089 |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2019-07-26 |
| Authorized Official Name | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2537334500 |
| 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 |
550002083 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1659647808 | 05 |
| Other Name | Type Code |
|---|---|
| Herndon Dialysis | Doing Business As Name - Organization |
| Street Address |
560 E HERNDON AVE STE 101 |
| City | FRESNO |
| State | CA |
| Zip Code | 93720-2907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831715069 | Michele Tilton | Dietitian, Registered | 560 E Herndon Ave, Fresno, CA 93720-2907 | 2020-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366061129 | Ariel Lok Yen Leung | Student in an Organized Health Care Education/Training Program | 1313 East Herndon Ave, St 105, Fresno, CA 93720 | 2020-04-13 |
| 1457992513 | Brittany Nichole Willis | Audiologist | 1351 E Spruce Ave Ste 130, Fresno, CA 93720 | 2019-09-30 |
| 1013567668 | Taylor Courteney Cox | Physical Therapist | 7080 N. Maple Ave #101, Fresno, CA 93720 | 2019-09-16 |
| 1457909152 | Lillian M Augilera | Technician | 8419 N Dearing Ave, Fresno, CA 93720 | 2019-08-27 |
| 1215581764 | Sterling Hospitalist Medical Group, Inc. | Clinic/Center | 1191 E. Herndon Avenue Suite 103, Fresno, CA 93720 | 2019-08-01 |
| 1376006429 | Nancy Minh Thao Dang | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105, Fresno, CA 93720 | 2019-04-06 |
| 1366904716 | Shankar Nair | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105., Fresno, CA 93720 | 2019-04-04 |
| 1861979544 | Powell Pediatric Dentistry Chestnut Partnership | Dentist | 7005 N. Chestnut Ave Ste 101, Fresno, CA 93720 | 2018-07-25 |
| 1669967311 | Sierra Pacific Orthopaedic Center Medical Group Inc | Specialist | 1270 E. Spruce, Fresno, CA 93720 | 2018-06-26 |
| 1689168700 | Vinita Vishnoi | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105, Fresno, CA 93720 | 2018-06-21 |
| Find all providers in zip 93720 | ||||
| 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 |
|---|---|---|---|---|
| 1376152645 | Navin Dialysis, LLC | Clinic/Center | 4314 E Jensen Ave, Fresno, CA 93706-9049 | 2020-07-23 |
| 1942784541 | Fresenius Medical Care Fresno North Home, LLC | Clinic/Center | 6733 N Willow Ave Ste 101, Fresno, CA 93710-5953 | 2018-09-19 |
| 1235677832 | Fresenius Medical Care Fresno, LLC | Clinic/Center | 1899 N Helm Ave, Suite 102, Fresno, CA 93727-1612 | 2017-02-03 |
| 1669840146 | Fresenius Medical Care Fresno, LLC | Clinic/Center | 1899 N Helm Ave Ste 101, Fresno, CA 93727-1612 | 2015-09-14 |
| 1497157820 | Ordust Dialysis LLC | Clinic/Center | 6655 N Milburn Ave, Fresno, CA 93722 | 2014-09-17 |
| 1669717039 | Fresenius Medical Care Fresno, LLC | Clinic/Center | 6737 N Willow Ave, Bldg C, Fresno, CA 93710-5954 | 2012-12-11 |
| 1649515115 | Fresenius Medical Care Fresno, LLC | Clinic/Center | 3036 North 1st St., Suite 144, Fresno, CA 93726-6818 | 2012-12-10 |
| 1821269069 | Bio-medical Applications of California, Inc. | Clinic/Center | 6737 N Willow Ave Ste 101, Fresno, CA 93710-5954 | 2008-03-16 |
| 1073705018 | Total Renal Care Inc | Clinic/Center | 6121 N Thesta St Ste 102, Fresno, CA 93710-5294 | 2007-08-14 |
| 1215049119 | Bio-medical Applications of Fresno, Inc. | Clinic/Center | 3636 North First Street, #144, Fresno, CA 93726-6818 | 2006-08-31 |
| Find all providers in FRESNO | ||||
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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.