Midwest Legacy Capital LLC

Primary specialty

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

Legal business name

MIDWEST LEGACY CAPITAL LLC

Doing business as

At Home Kidneycare

Practice address

W4233 State Rd 54
Black Creek, WI 54106-8633

Phone

(920) 915-5202

NPI assigned

Mar 26, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Thomas A Dudley

Title

Ceo

Phone

(920) 915-5202

Specialties & licenses 1

Addresses

Other names 1

• At Home Kidneycare Doing business as

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1972008704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W4233 STATE RD 54",
            "city": "BLACK CREEK",
            "state": "WI",
            "postal_code": "541068633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W4233 STATE RD 54",
            "city": "BLACK CREEK",
            "state": "WI",
            "postal_code": "541068633",
            "telephone_number": "920-915-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST LEGACY CAPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-26",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "920-915-5202",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "At Home Kidneycare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "At Home Kidneycare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Faudree, MD
• Brianna Marie Karweick
• Darrel D. Klemp, D.C.
• Thomas Emery Lornson, D.D.S.
• McKay & Associates
• Zandy Moes, RN-BSN
• Kari Sheldon, MD
• Evan Veldt, PTA
• Chelsea Marie Wellens

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Black Creek, WI
• Providers in Black Creek, 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 Mar 26, 2018; 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.