End Stage Renal Disease Home Care Provider Agency

Primary specialty

Dialysis Equipment & Supplies (DME)Taxonomy code 332BD1200X

Legal business name

END STAGE RENAL DISEASE HOME CARE PROVIDER AGENCY

Practice address

22356 W Lasso LN
Buckeye, AZ 85326-5979

Phone

(623) 210-2710

NPI assigned

Dec 20, 2012

Last updated

Sep 11, 2014By 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. William Henry Davis Jr.

Title

Owner/Supply

Phone

(414) 759-8587

Specialties & licenses 1

Addresses

Other names 1

• none Other name

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

{
    "created_epoch": "1355961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410393600000",
    "number": "1083950984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6911",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853380632",
            "telephone_number": "414-759-8587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22356 W LASSO LN",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853265979",
            "telephone_number": "623-210-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "END STAGE RENAL DISEASE HOME CARE PROVIDER AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-20",
        "last_updated": "2014-09-11",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "OWNER/SUPPLY",
        "authorized_official_telephone_number": "414-759-8587",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "332BD1200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "none",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Buckeye, AZ
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; 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.