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Ambulatory Health Care Facilities Clinic/Center End-Stage Renal Disease (ESRD) Treatment

Provider NPI: 1962943019

Organization Information:
Organization is Subpart
Authorized Official:  MARK R FAWCETT  SENIOR VP & TREASURER  781-699-9000

Practice Location:
Tel: 317-791-8362  Fax: 317-791-8799

Business Mailing Address:
Tel: 317-791-8362  Fax: 317-791-8799

NPI Information:
NPI: 1962943019
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y261QE0700XAmbulatory Health Care Facilities
End-Stage Renal Disease (ESRD) Treatment

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 261QE0700X





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