Basic Information
| Provider Information | |||||||||
| NPI: | 1104467984 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DSI NEWBURGH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 639743 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452639743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454763788 | ||||||||
| FaxNumber: | 8454763787 | ||||||||
| Practice Location | |||||||||
| Address1: | 39 N PLANK RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125502124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454763788 | ||||||||
| FaxNumber: | 8454763787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2019 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | WEINBERG | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 2147362700 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | U.S. RENAL CARE, INC. | ||||||||
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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 |
No ID Information.