Organization
WESTERN NEW YORK DC, LLC
Active
Other names
Orchard Park Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
HERBERT S LAWSON (CFO)
(303) 785-7521
Entity
Organization
Contact information
Practice address
3801 TAYLOR RD, ORCHARD PARK, NY 14127-2232
(716) 209-7200
(716) 209-7206
Mailing address
2100 CENTRAL AVE, SUITE 201, BOULDER, CO 80301-2838
(303) 785-7523
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
1401229R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378002
BLUE CROSS PROVIDER NUMBE
NY
05
—
01984981
—
NY
01
—
2V
INDEPENDENT HEALTH
NY
Enumeration date
11/21/2006
Last updated
08/22/2020
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