The Dialysis Center of West Philadelphia LLC

Primary specialty

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

Legal business name

THE DIALYSIS CENTER OF WEST PHILADELPHIA LLC

Doing business as

The Dialysis Center of West Philadelphia at Mill Creek

Practice address

4800 Brown St Ste 201
Philadelphia, PA 19139-2106

Phone

(215) 581-4993

Fax

(215) 883-1573

NPI assigned

Aug 26, 2015

Last updated

Mar 11, 2020By 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

Shari K Cousins

Title

Sr. VP of Clinical & Regulatory

Phone

(978) 922-3080

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Dialysis Center of West Philadelphia at Mill Creek Doing business as

Locations

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

{
    "created_epoch": "1440547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1184091142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 BROWN ST",
            "address_2": "SUITE 201",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191392126",
            "telephone_number": "215-581-4993",
            "fax_number": "215-883-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 BROWN ST STE 201",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191392106",
            "telephone_number": "215-581-4993",
            "fax_number": "215-883-1573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DIALYSIS CENTER OF WEST PHILADELPHIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-26",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "COUSINS",
        "authorized_official_first_name": "SHARI",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SR. VP OF CLINICAL & REGULATORY",
        "authorized_official_telephone_number": "978-922-3080"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1032188170001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dialysis Center of West Philadelphia at Mill Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; 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.