WALLIS DIALYSIS LLC (NPI# 1902270721) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902270721 |
| Entity Type | Organization |
| Organization Name | WALLIS DIALYSIS LLC |
| Other Organization Name | RAVENNA DIALYSIS |
| Practice Address |
600 Enterprise Parkway Ravenna OH 44266-0001 |
| Mailing Address |
5200 Virginia Way L&c Dept Brentwood TN 37027-7569 |
| Practice Telephone | 6153416793 |
| Practice Fax Number | 8664093229 |
| Mailing Telephone | 6153416793 |
| Mailing Fax Number | 8664093229 |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2015-11-17 |
| 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 |
| Other Name | Type Code |
|---|---|
| Ravenna Dialysis | Doing Business As Name - Organization |
| Street Address |
600 ENTERPRISE PARKWAY |
| City | RAVENNA |
| State | OH |
| Zip Code | 44266-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407409501 | Jeffrey Michael Jones | Hearing Instrument Specialist | 131 E. Hain St Beltone Hearing Care Center, Ravenna, OH 44266 | 2019-07-18 |
| 1285286443 | Robert Ailes Lax | Counselor | 246 S. Chestnut St., Ravenna, OH 44266 | 2019-07-09 |
| 1841792314 | Jason Troyer | Case Manager/Care Coordinator | 3920 Lover's Lane, Ravenna, OH 44266 | 2018-03-01 |
| 1316446370 | Jacquelin Grace Claren | Case Manager/Care Coordinator | 3920 Lovers Lane, Ravenna, OH 44266 | 2018-02-06 |
| 1164921318 | Tammy M Morris | Counselor | 4771 Washington Ave., Ravenna, OH 44266 | 2018-02-02 |
| 1306360219 | Megan Kathryn Marsh | Nurse Practitioner | 3215 Menough Rd, Ravenna, OH 44266 | 2017-08-01 |
| 1063875110 | Mary Kathryn Revello | Home Health Aide | 103 N.scycamore St, Ravenna 44266, OH 44266 | 2016-04-05 |
| 1396114302 | Theresa Brooks Kotlar | Registered Nurse | 7174 Colonial Place, Ravenna, OH 44266 | 2015-09-20 |
| 1811384118 | Okap Kwon Md Inc | Internal Medicine | 964 East Main Street, Ravenna, OH 44266 | 2015-04-24 |
| 1104223783 | Julie Winkler | Speech-Language Pathologist | 639 W. Main St, Ravenna, OH 44266 | 2014-11-26 |
| Find all providers in zip 44266 | ||||
| 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 |
|---|---|---|---|---|
| 1528433547 | Total Renal Care Inc | Clinic/Center | 600 Enterprise Pkwy, Ravenna, OH 44266-8054 | 2015-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235744616 | Akron Renal Care Group, LLC | Clinic/Center | 2583 Center Rd, Hinckley, OH 44233-9561 | 2020-09-11 |
| 1366057747 | Akron Renal Care Group, LLC | Clinic/Center | 9200 Staples Dr Ste A, Streetsboro, OH 44241-3950 | 2020-09-11 |
| 1518570886 | Independent Dialysis Group Northeast Ohio LLC | Clinic/Center | 48444 Bell School Rd Ste 4, Calcutta, OH 43920-9646 | 2020-08-26 |
| 1871106401 | Akron Renal Care Group, LLC | Clinic/Center | 401 Devon Pl Ste 100, Kent, OH 44240-6481 | 2020-08-24 |
| 1558985663 | Wyandot Dialysis Clinic LLC | Clinic/Center | 1207 E Wyandot Ave, Upper Sandusky, OH 43351-9647 | 2020-06-04 |
| 1245854876 | Concerto Ohio LLC | Clinic/Center | 2111 S Green Rd, South Euclid, OH 44121-3350 | 2020-05-29 |
| 1548899602 | Northeast Ohio Home Dialysis LLC | Clinic/Center | 2819 S Hayes Ave Ste 8, Sandusky, OH 44870-5391 | 2020-04-02 |
| 1982242954 | Center for Dialysis Care Beachwood Home Care LLC | Clinic/Center | 3755 Orange Pl Ste 103, Beachwood, OH 44122-4455 | 2019-12-20 |
| 1639715808 | Bullock Dialysis LLC | Clinic/Center | 2290 Ferguson Rd, Cincinnati, OH 45238 | 2019-11-22 |
| 1912554486 | Usrc Tiffin, LLC | Clinic/Center | 100 Shaffer Park Dr Ste A, Tiffin, OH 44883-8536 | 2019-08-20 |
| Find all providers with the same taxonomy | ||||
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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.