Organization Name: | PRODIGY DIALYSIS |
NPI Number: | 1184868051 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEORGE J FREM (MEDICAL DIRECTOR) |
Mailing Address: | 1100 W High St Ebensburg |
State: | PA US |
Postal Code: | 159311706 |
Phone Number: | 8144198107 |
Fax Number: | 8144198108 |
NPI Enumeration Date: | 04/23/2009 |
NPI Last Update Date: | 02/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | MD042825E |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |