RANDOLPH DIALYSIS LLC (NPI# 1659796233) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659796233 |
| Entity Type | Organization |
| Organization Name | RANDOLPH DIALYSIS LLC |
| Other Organization Name | THREE RIVERS DIALYSIS |
| Practice Address |
6721 Old Trail Rd Ste 100 Fort Wayne IN 46809-2655 |
| Mailing Address |
5200 Virginia Way L&c Dept Brentwood TN 37027-7569 |
| Practice Telephone | 2604788582 |
| Practice Fax Number | 2604788566 |
| Mailing Telephone | 6153204514 |
| Mailing Fax Number | 8665949961 |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2019-11-06 |
| 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 |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 300009689A | 05 |
| Other Name | Type Code |
|---|---|
| Three Rivers Dialysis | Doing Business As Name - Organization |
| Street Address |
6721 OLD TRAIL RD STE 100 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46809-2655 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497038574 | Zachary L Roberts | Pharmacist | 12279 Bluffton Road, Fort Wayne, IN 46809 | 2011-09-24 |
| 1679660278 | Kool Smiles In Ft. Wayne, PC | Dentist | 1852 Bluffton Road, Ft. Wayne, IN 46809 | 2006-10-06 |
| 1477512564 | Brian Thomas Raypole | Specialist/Technologist | 5050 N. Clinton Street, Fort Wayne, IN 46809 | 2006-03-20 |
| 1669016895 | Trinity Health Pharmacy Services, LLC | Pharmacy | 12279 Bluffton Road, Fort Wayne, IN 46809 | 2019-10-31 |
| 1871049981 | Mark Sexton | Physical Therapist | 3534 Brooklyn Ave, Fort Wayne, IN 46809 | 2016-08-29 |
| 1841573318 | Vicki Eileen Caccamo | Pharmacist | 6730 Bluffton Rd, Fort Wayne, IN 46809 | 2011-09-21 |
| 1104988112 | Karena Diane Schroeder | Physical Therapist | 3534 Brooklyn Ave, Fort Wayne, IN 46809 | 2006-12-15 |
| 1013084946 | David L Kuhn | Physical Therapist | 3534 Brooklyn Ave, Fort Wayne, IN 46809 | 2006-11-29 |
| 1265588404 | May R. Dahman | Specialist | 1733 Kinsmoor Ave, Fort Wayne, IN 46809-1025 | 2007-01-27 |
| 1134746209 | Laurel Schroeder | Occupational Therapist | 1726 Bluffton Rd, Fort Wayne, IN 46809-1305 | 2020-07-06 |
| Find all providers in zip 46809 | ||||
| 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 |
|---|---|---|---|---|
| 1558716019 | Duston Dialysis, LLC | Clinic/Center | 415 E Dupont Rd, Fort Wayne, IN 46825-2051 | 2016-05-03 |
| 1558635276 | Bridges Dialysis LLC | Clinic/Center | 3233 E Coliseum Blvd, Fort Wayne, IN 46805-1561 | 2012-02-27 |
| 1093012544 | Bridges Dialysis LLC | Clinic/Center | 1833 Magnavox Way, Fort Wayne, IN 46804-1539 | 2011-02-18 |
| 1003119876 | Bridges Dialysis LLC | Clinic/Center | 302 E Pettit Ave, Fort Wayne, IN 46806-3007 | 2010-12-16 |
| 1366745630 | Bridges Dialysis LLC | Clinic/Center | 4916 Illinois Rd, Suite 118, Fort Wayne, IN 46804-5116 | 2010-12-08 |
| 1770698524 | Maumee Dialysis Services, LLC | Clinic/Center | 10204 Dupont Circle Dr E, Fort Wayne, IN 46825-1611 | 2006-08-20 |
| 1174579551 | Isd Renal Inc | Clinic/Center | 3909 Lake Ave, Fort Wayne, IN 46805-5545 | 2006-05-26 |
| 1992751556 | Isd Renal Inc | Clinic/Center | 1940 Bluffton Rd, Fort Wayne, IN 46809-1307 | 2006-05-25 |
| 1639124886 | Dsi Renal Inc | Clinic/Center | 2414 Lake Ave, Fort Wayne, IN 46805-5406 | 2006-05-24 |
| 1386699445 | Isd Renal Inc | Clinic/Center | 7017 S Anthony Blvd, Fort Wayne, IN 46816-2016 | 2006-05-24 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46809 |
Please comment or provide details below to improve the information on RANDOLPH DIALYSIS LLC.
| 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.