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
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us