NPIMap

Blake Dialysis LLC

Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Cedarburg, WI

NPI 1497033229 · NPPES record last updated Feb 23, 2024

Key facts

NPI
1497033229
Entity type
Organization (NPI type 2)
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
Legal business name
BLAKE DIALYSIS LLC
Practice address
N54 W6135 Mill St
Ste 500
Cedarburg, WI 53012-2067
Phone
(262) 377-2158
Fax
(262) 377-2191
NPI assigned
Jul 27, 2011
Organization subpart
No

Authorized official

Name
Samuel T Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Other NPIs with the same Medicare PAC ID 1

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

Corporate family (same tax ID) 1

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

Member of 1

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20110830000255 WI Part a Provider - End-Stage Renal Disease Facility (ESRD) 9537339585 Practice locations: Cedarburg, WI

National Provider Directory

Tax ID family
Blake Dialysis LLC (2 organizations share this tax ID)

Locations

N54W6135 Mill St
Ste 500
Cedarburg, WI 53012
Phone (262) 377-2158

Specialties & licenses

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

Addresses

Primary practice location

N54 W6135 Mill St
Ste 500
Cedarburg, WI 53012-2067

Mailing address

5200 Virginia Way
L&C Department
Brentwood, TN 37027-7569
Phone (615) 341-6264

Other names

  • Mill Street HomeTraining Doing business as

Other providers in Cedarburg, WI

All providers in Cedarburg, WI · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wisconsin

Sources for this page

Verify at the official NPI Registry.