Community/Physicians Dialysis Center Fairborn, Limited

Primary specialty

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

License

0674DC Issued in OH

Legal business name

COMMUNITY/PHYSICIANS DIALYSIS CENTER FAIRBORN, LIMITED

Practice address

1266 N Broad St
Fairborn, OH 45324-5549

Phone

(937) 879-0433

Fax

(937) 879-0589

NPI assigned

May 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey S Spiers, RN,CNN

Title

Administrator

Phone

(937) 328-8933

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CPDCF Other name

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267747200000",
    "number": "1316993702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 S BURNETT RD",
            "address_2": "SUITE 110",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455052639",
            "telephone_number": "937-328-8921",
            "fax_number": "937-525-2466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1266 N BROAD ST",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453245549",
            "telephone_number": "937-879-0433",
            "fax_number": "937-879-0589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY/PHYSICIANS DIALYSIS CENTER FAIRBORN, LIMITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2010-03-05",
        "status": "A",
        "authorized_official_last_name": "SPIERS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "937-328-8933",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN,CNN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "OH",
            "license": "0674DC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2337297",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CPDCF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tina Collins-Skaggs
• Arianna Collins
• Madison Collins
• Rian Coman
• Christy Lynn Combs, CDCA
• Jordan Congleton, PTA
• Andrea L Cooper, PT
• Autumn Cooper
• Kewin Cooper
• Stephanie Cooper

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fairborn, OH
• Providers in Fairborn, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2010; 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.