Provider Demographics
NPI:1366405847
Name:DIALYSIS SERVICES OF PENNSYLVANIA, INC- LEMOYNE
Entity type:Organization
Organization Name:DIALYSIS SERVICES OF PENNSYLVANIA, INC- LEMOYNE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-694-0500
Mailing Address - Street 1:214 SENATE AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2339
Mailing Address - Country:US
Mailing Address - Phone:717-730-9701
Mailing Address - Fax:717-730-6223
Practice Address - Street 1:27 MILLER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1521
Practice Address - Country:US
Practice Address - Phone:717-730-6011
Practice Address - Fax:717-730-9086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIALYSIS CORPORATION OF AMERICA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1851OtherPA HIGHMARK
PA20007740OtherAMERIHEALTH MERCY
PA1504321OtherGATEWAY
PA30021413OtherKEYSTONE MERCY
PA0015293320001Medicaid
PA105531OtherGEISINGER HEALTH PLAN
PA1529332OtherHEALTHMATE
PA1529332OtherUNISON
PA1529332OtherAMERICHOICE HMO
PA5277373OtherAETNA
PA34493OtherHEALTH PARTNERS
PAPPA01548OtherPA CHRONIC RENAL
PA0015293320001Medicaid
PA0015293320001Medicaid