Organization
GSH DIALYSIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH COFFEY ACCOUNTANT (BUDGET/REIMBURSEMENT SPECIALIST)
(717) 270-7811
Entity
Organization
Contact information
Practice address
440 OAK ST, LEBANON, PA 17042-6243
(717) 274-7552
(717) 272-3061
Mailing address
440 OAK ST, LEBANON, PA 17042-6243
(717) 274-7552
(717) 272-3061
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
392557
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011692470001
—
PA
01
—
1601
HIGHMARK BLUE SHIELD
PA
01
—
392557
CAIC
PA
Enumeration date
08/02/2005
Last updated
08/22/2020
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