Basic Information
| Provider Information | |||||||||
| NPI: | 1083652531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPENA DIALYSIS SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 188 | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488010188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894663395 | ||||||||
| FaxNumber: | 9894667454 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 W CHISHOLM ST | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893563128 | ||||||||
| FaxNumber: | 9893580072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CURRIE | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | V.P. OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 9894663272 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 08966 | 01 | MI | BCBSM | OTHER | 09474 | 01 | MI | BCBSM | OTHER |