Ultimate Renal Care, LLC

Primary specialty

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

License

E2614 Issued in MD

Legal business name

ULTIMATE RENAL CARE, LLC

Practice address

2426 Chillum Rd
Hyattsville, MD 20782-3629

Phone

(301) 927-8808

Fax

(301) 927-8809

NPI assigned

Oct 2, 2006

Last updated

Aug 16, 2007By 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. Juan Gumabon Canlas

Title

Administrator

Phone

(301) 927-8808

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1134212970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2426 CHILLUM RD",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823629",
            "telephone_number": "301-927-8808",
            "fax_number": "301-927-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2426 CHILLUM RD",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823629",
            "telephone_number": "301-927-8808",
            "fax_number": "301-927-8809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE RENAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "CANLAS",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "GUMABON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "301-927-8808",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "E2614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Hyattsville, MD
• Providers in Hyattsville, MD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; 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.