Basic Information
| Provider Information | |||||||||
| NPI: | 1518171271 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | READING DIALYSIS CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 536175 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152535903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103705323 | ||||||||
| FaxNumber: | 6103705329 | ||||||||
| Practice Location | |||||||||
| Address1: | 965 BERKSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196101229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103705323 | ||||||||
| FaxNumber: | 6103705329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | FLOOD | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | DAVIS | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3055345102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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 | 1020162360001 | 05 | PA | MEDICAID |