Organization
INDEPENDENT DIALYSIS FOUNDATION, INC
Active
Parent organization
INDEPENDENT DIALYSIS FOUNDATION, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
INDEPENDENT DIALYSIS FOUNDATION, INC
Authorized official
ZEKE AYELE (DIRECTOR OF INFORMATION SYSTEMS)
(410) 468-0900
Entity
Organization
Contact information
Practice address
611 S CHARLES ST, BALTIMORE, MD 21230-3801
(410) 468-0900
(410) 468-0911
Mailing address
840 HOLLINS ST, BALTIMORE, MD 21201-1024
(410) 468-0900
(410) 468-0911
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2582
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005759000
—
WV
01
—
0125608
AETNA
MD
05
—
01689292
—
PA
01
—
0704865003
CIGNA
MD
01
—
21506
JAI MEDICAL
MD
01
—
215143
MDIPA
MD
01
—
576241-03
CAREFIRST
MD
01
—
PS8
FEP
MD
Enumeration date
08/04/2006
Last updated
07/16/2007
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