Basic Information
| Provider Information | |||||||||
| NPI: | 1801837372 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DSI RENAL INC | ||||||||
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| OtherOrganizationName: | DSI LEES SUMMIT RENAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 UNION ST | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372191733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154670134 | ||||||||
| FaxNumber: | 6152342422 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 NE MISSOURI ROAD | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165243312 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | BARR | ||||||||
| AuthorizedOfficialFirstName: | GRETCHEN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 6154670134 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 91284051 | 01 | MO | BCBS KANSAS CITY | OTHER |