| Organization Name: | MACHESNEY BAY DIALYSIS LLC |
| NPI Number: | 1770957599 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
| Mailing Address: | 7101 N Perryville Rd Machesney Park |
| State: | IL US |
| Postal Code: | 611157700 |
| Phone Number: | 6153416657 |
| Fax Number: | 8666519495 |
| NPI Enumeration Date: | 11/17/2015 |
| NPI Last Update Date: | 03/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |