Organization
PERITONEAL DIALYSIS CONCEPTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID F SHEPHERD (VICE PRESIDENT)
(248) 642-5038
Entity
Organization
Contact information
Practice address
4700 SPRINGBORO PIKE, STE 300, DAYTON, OH 45439
(937) 294-6030
(937) 294-4345
Mailing address
30100 TELEGRAPH RD, #200, BINGHAM FARMS, MI 48025-4514
(248) 723-0224
(248) 642-7852
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000002891
ANTHEM
OH
05
—
0126858
—
OH
01
—
6800192
UNITED HEALTH CARE
—
Enumeration date
07/07/2006
Last updated
04/15/2009
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