Organization
DIALYSIS ACCESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJESH ALLA M.D. (MEDICAL DIRECTOR)
(309) 762-5570
Entity
Organization
Contact information
Practice address
400 JOHN DEERE RD, BUILDING 2, MOLINE, IL 61265-6898
(309) 797-0594
(309) 762-5297
Mailing address
400 JOHN DEERE RD, BUILDING 2, MOLINE, IL 61265-6898
(309) 797-0594
(309) 762-5297
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51756
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
01
—
IL5611
MEDICARE PTAN
IL
Enumeration date
08/25/2010
Last updated
08/29/2014
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