Basic Information
| Provider Information | |||||||||
| NPI: | 1285697706 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DCA OF CARLISLE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | U S RENAL CARE CARLISLE DIALYSIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19119 | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724036601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709315400 | ||||||||
| FaxNumber: | 8709315418 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 NOBLE BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170134100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172583099 | ||||||||
| FaxNumber: | 7172583632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | WEINBERG | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT & SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 2142134700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | U S RENAL CARE INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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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 | 0016627710001 | 05 | PA | MEDICAID | 1520690 | 01 | PA | GATEWAY | OTHER | 392627 | 01 | PA | AUSA LIFE INSURANCE | OTHER | 392627 | 01 | PA | COMBINED INSURANCE | OTHER | 392627 | 01 | PW | CAPITAL BLUE CROSS | OTHER | 392627 | 01 | PA | CAREFIRST | OTHER | 392627 | 01 | PA | FRANK J SIRACUSA | OTHER | 392627 | 01 | PA | CORNING HEALTH | OTHER | 392627 | 01 | PA | FLEET RESERVE | OTHER | 392627 | 01 | PA | CIGNA | OTHER | 392627 | 01 | PA | AARP/UNITED HEALTHCARE | OTHER | 392627 | 01 | PA | CARPENTERS HEALTH | OTHER | 392627 | 01 | PA | AMERICAN MARITIME | OTHER | 392627 | 01 | PA | BOARD OF PENSIONS | OTHER | 5694652 | 01 | PA | AETNA | OTHER | 1662771 | 01 | PA | HEALTHMATE | OTHER | 392627 | 01 | PA | ADVANTRA | OTHER | PPA01553 | 01 | PA | PA CHRONIC RENAL PROGRAM | OTHER |