Ellicott Kidney Center LLC

Primary specialty

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

Legal business name

ELLICOTT KIDNEY CENTER LLC

Practice address

3000 N Ridge Rd
Suite a
Ellicott City, MD 21043-3311

Phone

(410) 465-0273

Fax

(410) 465-0360

NPI assigned

Jan 22, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Jason Boucher

Title

Cfo

Phone

(978) 922-3080

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Don E Williamson, MD

  • Nephrology Physician
  • Augusta, GA
  • NPI 1912984790
  NPD (past)

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1255754677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N RIDGE RD",
            "address_2": "SUITE A",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210433311",
            "telephone_number": "410-465-0273",
            "fax_number": "410-465-0360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N RIDGE RD",
            "address_2": "SUITE A",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210433311",
            "telephone_number": "410-465-0273",
            "fax_number": "410-465-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLICOTT KIDNEY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-22",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "978-922-3080",
        "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": "422934700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellicott City Primary Care Medicine PA
• Ellicott City Total Eye Care LLC
• Ellicott City Wellness Chiropractic, L.L.C.
• Ellicott City Womens Health
• Ellicott Dental & Specialty LLC (BluePointe Dental (Ellicott))
• Mia Ellis, LCPC
• Aiman Eltahir, DPT
• Eman Inc
• Enchanted Medical LLC (Enchanted Medical Supplies)
• Nonso Enekwe, PHARM.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ellicott City, MD
• Providers in Ellicott City, 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 Mar 21, 2019; 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.