Targhee Dialysis, LLC

Primary specialty

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

Legal business name

TARGHEE DIALYSIS, LLC

Practice address

4435 Aicholtz Rd
Ste 800B
Cincinnati, OH 45245-1690

Phone

(513) 752-8301

Fax

(513) 752-8483

NPI assigned

Nov 28, 2018

Organization subpart

No

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

Authorized official

Name

Sam Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eastgate Home Training Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Targhee Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cincinnati, OH
  • NPI 1417550476

  0042559262

  Same PAC ID

Tax ID family

College Hill Dialysis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Targhee Dialysis, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cincinnati, OH
  • NPI 1417550476
  NPD tax ID

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

{
    "created_epoch": "1543363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1083184451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 AICHOLTZ RD",
            "address_2": "STE 800B",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452451690",
            "telephone_number": "513-752-8301",
            "fax_number": "513-752-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TARGHEE DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-28",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "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": "0366852",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastgate Home Training",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eastgate Home Training",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph George Taranto, MD
• Adam Tardio
• Fariha Tareen, M.D.
• Zackary Tareky
• Target Health Care LLC
• Targhee Dialysis, LLC
• Rabia Tari, MD
• Taricel Management Staffing,LLC
• Richard Tarin II, RN, CNP
• Javeria Tariq, MD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.