Blancott Dialysis, LLC

Primary specialty

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

Legal business name

BLANCOTT DIALYSIS, LLC

Doing business as

Avonworth Dialysis

Practice address

259 Mount Nebo Pointe Rd
Pittsburgh, PA 15237-1313

Phone

(412) 364-3238

Fax

(412) 364-0523

NPI assigned

Feb 5, 2019

Organization subpart

No

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

Authorized official

Name

John D Winstel

Title

Chief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Avonworth Dialysis Doing business as

Member of 1

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

• Renal Treatment Centers Mid Atlantic Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Goldsboro, NC
  • NPI 1174086698

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1538624499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-341-6410",
            "fax_number": "888-662-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 MOUNT NEBO POINTE RD",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152371313",
            "telephone_number": "412-364-3238",
            "fax_number": "412-364-0523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLANCOTT DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-05",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "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": "103704873",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avonworth Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avonworth Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sandra Ann Blakowski, M.D.
• Robert O Blanc, MS, ATC
• Josiah Blanchard, PA-C
• Katherine Somers Blanchet
• Robert J Blanciak, BS RPH
• Callie Bland
• Trevor Bland
• Edith Diane Blandino, DMD
• Jamie Blando, RN
• Richard G Blank, D.M.D

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pittsburgh, PA
• Providers in Pittsburgh, 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 Dec 18, 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.