Life- Alysis Kidney Center, LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

302R00000X Issued in MI

Legal business name

LIFE- ALYSIS KIDNEY CENTER, LLC

Practice address

5830 Conner St
Detroit, MI 48213-3458

Phone

(313) 371-5433

Fax

(313) 371-6937

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Lyle Maruice Gray

Title

Partner

Phone

(313) 371-5433

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1255442190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 CONNER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482133458",
            "telephone_number": "313-371-5433",
            "fax_number": "313-371-6937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5830 CONNER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482133458",
            "telephone_number": "313-371-5433",
            "fax_number": "313-371-6937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE- ALYSIS KIDNEY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "LYLE",
        "authorized_official_middle_name": "MARUICE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "313-371-5433",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MI",
            "license": "302R00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4603219",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.