Hawthorn Kidney Center Wareham LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

HAWTHORN KIDNEY CENTER WAREHAM LLC

Practice address

2991 Cranberry Hwy
Suite F1
East Wareham, MA 02538-1354

Phone

(508) 295-5290

Fax

(508) 295-5291

NPI assigned

Dec 17, 2012

Last updated

Mar 16, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jonathan Wilcox

Title

Cfo

Phone

(978) 922-3080

Specialties & licenses 1

Addresses

Other identifiers 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Hawthorn Medical Associates, LLC

  • Durable Medical Equipment & Medical Supplies
  • N Dartmouth, MA
  • NPI 1619196201

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1023354289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2991 CRANBERRY HWY",
            "address_2": "SUITE F1",
            "city": "EAST WAREHAM",
            "state": "MA",
            "postal_code": "025381354",
            "telephone_number": "508-295-5290",
            "fax_number": "508-295-5291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2991 CRANBERRY HWY",
            "address_2": "SUITE F1",
            "city": "EAST WAREHAM",
            "state": "MA",
            "postal_code": "025381354",
            "telephone_number": "508-295-5290",
            "fax_number": "508-295-5291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWTHORN KIDNEY CENTER WAREHAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-17",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "978-922-3080",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110096821A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda L. Fontes
• Kristen Elizabeth Gibb
• Habit Opco
• John Haley
• Sang Hoon John Han, D.D.S.
• Melinda Lee Jackson
• Izabela Jeremus
• Letitia Michelle Johnson, LPN
• Brittany D Lague, LPN
• Jason Charles Laviolette

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in East Wareham, MA
• Providers in East Wareham, MA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.