ELLICOTT KIDNEY CENTER LLC – NPI #1255754677
Clinic/Center

ELLICOTT KIDNEY CENTER LLC is an AHC clinic located in ELLICOTT CITY, MD. NPPES has assigned the NPI number 1255754677 to ELLICOTT KIDNEY CENTER LLC on January 22, 2014. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QE0700X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment

The NPI profile was previously updated about 7 years ago on Mar 21, 2019. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ELLICOTT KIDNEY CENTER LLC below.

NPI Profile for
ELLICOTT KIDNEY CENTER LLC

NPI Number
1255754677
Enumeration Date

(more than 12 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
ELLICOTT KIDNEY CENTER LLC
Primary location
3000 N RIDGE RD
SUITE A
ELLICOTT CITY, MD 21043-3311
Phone: (410) 465-0273 Fax: (410) 465-0360
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
JASON BOUCHER
CFO
Phone: (978) 922-3080
Updated
Identifiers

Identifiers for ELLICOTT KIDNEY CENTER LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDMD422934700
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QE0700X
- Clinic/Center / End-Stage Renal Disease (ESRD) Treatment (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.