NPIMap

Organization Active NPI

Jackson County Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tacoma, WA
National Provider Identifier
1720406739
Registry record updated Apr 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
04D0955996 Issued in AR
Legal business name
JACKSON COUNTY DIALYSIS
Practice address
1423 Pacific Ave
Tacoma, WA 98402-4203
Phone
(253) 382-1752
NPI assigned
Apr 7, 2014
Last updated
Apr 7, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2014

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

Authorized official

Name
Kent Thiry, CHAIRMAN
Title
Ceo
Phone
(303) 876-6000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 04D0955996 AR Primary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 1871898965 AR

Addresses

Primary practice location

1423 Pacific Ave
Tacoma, WA 98402-4203

Mailing address

1912 McLain St
Pratt Square
Newport, AR 72112-3659
Phone (870) 523-2607

Other identifiers 1

IdentifierTypeStateIssuer
190060134MedicaidAR

Other names 1

  • Capes Dialysis LLC Other name

National Provider Directory

National Provider Directory
Tax ID family
Capes Dialysis LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396828800000",
    "number": "1720406739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 MCLAIN ST",
            "address_2": "PRATT SQUARE",
            "city": "NEWPORT",
            "state": "AR",
            "postal_code": "721123659",
            "telephone_number": "870-523-2607",
            "fax_number": "870-523-2824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984024203",
            "telephone_number": "253-382-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY DIALYSIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-07",
        "last_updated": "2014-04-07",
        "status": "A",
        "authorized_official_last_name": "THIRY",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "303-876-6000",
        "authorized_official_credential": "CHAIRMAN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AR",
            "license": "04D0955996",
            "primary": true
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AR",
            "license": "1871898965",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "190060134",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capes Dialysis LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; 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.