Organization Active NPI

Midwest Dialysis Center-Good Hope Branch, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Milwaukee, WI
National Provider Identifier
1104859990
Registry record updated Oct 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
MIDWEST DIALYSIS CENTER-GOOD HOPE BRANCH, INC
Practice address
7701 W Clinton Ave
Milwaukee, WI 53223-4527
Phone
(414) 760-3090
Fax
(414) 760-3068
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2011

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

Authorized official

Name
Mr. David A Kurz
Title
V.P. Operations
Phone
(414) 762-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

7701 W Clinton Ave
Milwaukee, WI 53223-4527

Mailing address

335 Mahn CT
Oak Creek, WI 53154-2155
Phone (414) 762-2020

Other identifiers 1

IdentifierTypeStateIssuer
42054400MedicaidWI

National Provider Directory

National Provider Directory

Locations

7701 W Clinton Ave
Milwaukee, WI 53223
Phone (414) 760-3090

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1104859990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 MAHN CT",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531542155",
            "telephone_number": "414-762-2020",
            "fax_number": "414-762-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7701 W CLINTON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532234527",
            "telephone_number": "414-760-3090",
            "fax_number": "414-760-3068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST DIALYSIS CENTER-GOOD HOPE BRANCH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2011-10-21",
        "status": "A",
        "authorized_official_last_name": "KURZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "V.P. OPERATIONS",
        "authorized_official_telephone_number": "414-762-2020",
        "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": "42054400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; 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.