Dubuque Internal Medicine, PC

Primary specialty

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

Legal business name

DUBUQUE INTERNAL MEDICINE, PC

Doing business as

Tri State Dialysis Richland Center

Practice address

190 N Orange St
Richland Center, WI 53581-2163

Phone

(563) 557-9111

NPI assigned

Oct 13, 2020

Last updated

Aug 28, 2024By 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

Mariah Ann Brandenburg

Title

Administration

Phone

(563) 589-4066

Specialties & licenses 1

Addresses

Other names 1

• Tri State Dialysis Richland Center Doing business as

Locations

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1679171599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 DELHI ST STE 100",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520016320",
            "telephone_number": "563-557-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 N ORANGE ST",
            "city": "RICHLAND CENTER",
            "state": "WI",
            "postal_code": "535812163",
            "telephone_number": "563-557-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBUQUE INTERNAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "BRANDENBURG",
        "authorized_official_first_name": "MARIAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "563-589-4066"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri State Dialysis Richland Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tri State Dialysis Richland Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Richland Center, WI
• Providers in Richland Center, WI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.