NPIMap

Organization Active NPI

Fayetteville Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tacoma, WA
National Provider Identifier
1811315971
Registry record updated Apr 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
04D0922946 Issued in AR
Legal business name
FAYETTEVILLE DIALYSIS
Practice address
1423 Pacific Ave
Tacoma, WA 98402-4203
Phone
(253) 382-1752
NPI assigned
Apr 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 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 04D0922946 AR Primary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 1295913416 AR

Addresses

Primary practice location

1423 Pacific Ave
Tacoma, WA 98402-4203

Mailing address

509 E Millsap Rd
Ste 111
Fayetteville, AR 72703-4067
Phone (479) 443-6688

Other identifiers 1

IdentifierTypeStateIssuer
168261134MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Davita Upstate Dialysis758 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396569600000",
    "number": "1811315971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 E MILLSAP RD",
            "address_2": "STE 111",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034067",
            "telephone_number": "479-443-6688"
        },
        {
            "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": "FAYETTEVILLE DIALYSIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-04",
        "last_updated": "2014-04-04",
        "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": "04D0922946",
            "primary": true
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AR",
            "license": "1295913416",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168261134",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 4, 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.