Dialysis Access of Minnesota, L.L.C.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

DIALYSIS ACCESS OF MINNESOTA, L.L.C.

Practice address

600 County Road D W
New Brighton, MN 55112-3519

Phone

(763) 561-5349

Fax

(763) 561-6280

NPI assigned

Feb 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John R Gray, M.D.

Title

President

Phone

(763) 561-5349

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669512042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SHINGLE CREEK PKWY",
            "address_2": "SUITE 300",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302128",
            "telephone_number": "763-561-5349",
            "fax_number": "763-561-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 COUNTY ROAD D W",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551123519",
            "telephone_number": "763-561-5349",
            "fax_number": "763-561-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS ACCESS OF MINNESOTA, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-561-5349",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Anne De Wilde, M.A., LPCC
• Mason Alan Decambaliza
• Amanda Dekanick
• Kathrynne Delgado, MS, MA, LMFT
• Marsha Dettloff
• Diverse Disability Services LLC
• Kathy Ann Dixon, LPC
• Wade Dorcas
• Dr My Pang Kou Vang DDS, PLLC
• Christine Dresel

• Ambulatory Surgical Clinic/Center in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.