Organization
PRODIGY DIALYSIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORY YACYNYCH (PRACTICE MANAGER)
(814) 299-4676
Entity
Organization
Contact information
Practice address
387 THEATRE RD, CARROLLTOWN, PA 15722-7805
(814) 539-0798
(814) 536-4751
Mailing address
88 OSBORNE ST, JOHNSTOWN, PA 15905-4146
(814) 539-0798
(814) 536-4751
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
MD042825E
PA
Other
Enumeration date
02/29/2012
Last updated
09/25/2012
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