NPIMap

Organization Active NPI

Southeastern Renal Dialysis L.C.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Madison, IA
National Provider Identifier
1609988617
Registry record updated Mar 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SOUTHEASTERN RENAL DIALYSIS L.C.
Practice address
4703 Avenue L
Fort Madison, IA 52627-9505
Phone
(319) 372-7996
NPI assigned
Aug 31, 2006
Organization subpart
Yes
Parent organization
SOUTHEASTERN RENAL DIALYSIS L.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2012

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

Authorized official

Name
Mrs. Mary Liechty
Title
Administrator
Phone
(319) 385-6728

Specialties & licenses 1

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

Addresses

Primary practice location

4703 Avenue L
Fort Madison, IA 52627-9505

Mailing address

507 S White St
Mt Pleasant, IA 52641-2625
Phone (319) 385-6564

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061003000509 IA Part A Provider - End-Stage Renal Disease Facility (ESRD) 6608871249 Practice locations: Fort Madison, IA

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Southeastern Renal Dialysis, LC - Ft MadisonCCN 162537
Overall star rating
5.0 of 5
Ownership
Profit
Certified
Apr 13, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
12

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Renal Dialysis LC5 organizations share this tax ID, including this one
Part of
Southeastern Renal Dialysis LC

Other organizations with this tax ID 4

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

Member of 2

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

Locations

4703 Avenue L
Fort Madison, IA 52627
Phone (319) 372-7996

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1609988617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 S WHITE ST",
            "city": "MT PLEASANT",
            "state": "IA",
            "postal_code": "526412625",
            "telephone_number": "319-385-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4703 AVENUE L",
            "city": "FORT MADISON",
            "state": "IA",
            "postal_code": "526279505",
            "telephone_number": "319-372-7996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN RENAL DIALYSIS L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEASTERN RENAL DIALYSIS L.C.",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "LIECHTY",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "319-385-6728",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Madison, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.