NPIMap

Organization Active NPI

Southeastern Renal Dialysis L.C.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fairfield, IA
National Provider Identifier
1144490178
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SOUTHEASTERN RENAL DIALYSIS L.C.
Practice address
2000 A S Main St
Fairfield, IA 52556
Phone
(641) 469-3313
NPI assigned
Mar 5, 2008
Organization subpart
Yes
Parent organization
SOUTHEASTERN RENAL DIALYSIS L.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Mary Liechty
Title
Administrator
Phone
(319) 385-6728

Specialties & licenses 1

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

Addresses

Primary practice location

2000 A S Main St
Fairfield, IA 52556

Mailing address

507 S White St
Mt Pleasant, IA 52641-2625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080407000596 IA Part A Provider - End-Stage Renal Disease Facility (ESRD) 6608871249 Practice locations: Fairfield, IA

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Renal Dialysis LC5 organizations share this tax ID, including this one
Part of
Southeastern Renal Dialysis LC

Other organizations with this tax ID 4

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

Member of 2

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

NPI Registry JSON

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

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1144490178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 S WHITE ST",
            "city": "MT PLEASANT",
            "state": "IA",
            "postal_code": "526412625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 A S MAIN ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "52556",
            "telephone_number": "641-469-3313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN RENAL DIALYSIS L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEASTERN RENAL DIALYSIS L.C.",
        "enumeration_date": "2008-03-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LIECHTY",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "319-385-6728",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.