Organization
ELLICOTT CITY DIALYSIS CENTER LLC
Active
Organization
ELLICOTT CITY DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON BOUCHER (CFO)
(978) 922-3080
Entity
Organization
Contact information
Practice address
3419 PLUM TREE DR, SUITES 103-106, ELLICOTT CITY, MD 21042-3805
(410) 750-8426
(410) 750-8428
Mailing address
3419 PLUM TREE DR, SUITES 103-106, ELLICOTT CITY, MD 21042-3805
(410) 750-8426
(410) 750-8428
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
05
—
412495200
—
MD
Enumeration date
04/04/2007
Last updated
03/22/2019
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up