Outer Banks Dialysis Center LLC

Primary specialty

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

Legal business name

OUTER BANKS DIALYSIS CENTER LLC

Practice address

115 Exeter St
Manteo, NC 27954-9400

Phone

(252) 475-3530

Fax

(252) 475-3534

NPI assigned

Jul 31, 2018

Last updated

Jul 31, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Todd J Warlitner

Title

Cfo

Phone

(252) 449-4514

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532995200000",
    "number": "1548748718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 EXETER ST",
            "city": "MANTEO",
            "state": "NC",
            "postal_code": "279549400",
            "telephone_number": "252-475-3530",
            "fax_number": "252-475-3534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 EXETER ST",
            "city": "MANTEO",
            "state": "NC",
            "postal_code": "279549400",
            "telephone_number": "252-475-3530",
            "fax_number": "252-475-3534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTER BANKS DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-31",
        "last_updated": "2018-07-31",
        "status": "A",
        "authorized_official_last_name": "WARLITNER",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "252-449-4514"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3402598",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keith David Morris, RPH
• Mary Thurston Moynahan, FNP, BC
• North Carolina CVS Pharmacy LLC (CVS Pharmacy #05545)
• Ocracoke Health Center, Inc. (Manteo Community Health Center)
• Ocracoke Health Center, Inc. (Manteo Community Health Center Pharmacy)
• Outerbanks Professional Services LLC
• Jessica Phipps Owen, MS, LCMHC, LCAS
• Kevin Phillips, RPH
• Christopher James Roberts, LCSW, LCAS
• Kelly F Roberts, LCSW

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Manteo, NC
• Providers in Manteo, NC by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; 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.