Organization
PERITONEAL DIALYSIS CONCEPTS INC.
Active
Other names
Home Dialysis of Dayton
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID F SHEPERD (VICE PRESIDENT)
(248) 642-5038
Entity
Organization
Contact information
Practice address
1 ELIZABETH PL. 627 EDWIN C MOSES BLVD, SUITE 2B, DAYTON, OH 45417-1445
(937) 275-7402
(937) 424-3581
Mailing address
30100 TELEGRAPH RD, SUITE 200, BINGHAM FARMS, MI 48025-4516
(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
—
0133439
—
OH
01
—
6800191
UNITED HEALTH CARE
—
Enumeration date
07/07/2006
Last updated
09/09/2009
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