Basic Information
Provider Information
NPI: 1871531855
EntityType: 2
ReplacementNPI:  
OrganizationName: REGIONAL DIALYSIS SERVICES INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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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: 4901 JEFFERSON AVE
Address2:  
City: MIDLAND
State: MI
PostalCode: 486402905
CountryCode: US
TelephoneNumber: 9898397770
FaxNumber: 9898398550
Other Information
ProviderEnumerationDate: 06/03/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CURRIE
AuthorizedOfficialFirstName: SCOTT
AuthorizedOfficialMiddleName: D
AuthorizedOfficialTitleorPosition: V.P. OF FINANCE
AuthorizedOfficialTelephone: 9894663272
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QE0700X  Y Ambulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment

ID Information
IDTypeStateIssuerDescription
0943901MIBCBSMOTHER
0894301MIBCBSMOTHER


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