Provider Demographics
| NPI: | 1063971562 |
|---|---|
| Name: | CAMBRIDGE DIALYSIS GROUP LLC |
| Entity type: | Organization |
| Organization Name: | CAMBRIDGE DIALYSIS GROUP LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MANAGER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | HOWARD |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | FRIEDMAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 856-669-8237 |
| Mailing Address - Street 1: | 9396 E PURDUE AVE UNIT 120 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SCOTTSDALE |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85258-9105 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 856-669-8238 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 9396 E PURDUE AVE UNIT 120 |
| Practice Address - Street 2: | |
| Practice Address - City: | SCOTTSDALE |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85258-9105 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 856-669-8238 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-03-14 |
| Last Update Date: | 2019-03-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QE0700X | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment | |
| No | 2472R0900X | Technologists, Technicians & Other Technical Service Providers | Technician, Other | Renal Dialysis | Group - Multi-Specialty |
| No | 251E00000X | Agencies | Home Health | ||
| No | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | |
| No | 302R00000X | Managed Care Organizations | Health Maintenance Organization | ||
| No | 305R00000X | Managed Care Organizations | Preferred Provider Organization | ||
| No | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | |
| No | 251F00000X | Agencies | Home Infusion | ||
| No | 251J00000X | Agencies | Nursing Care | ||
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 261QR0200X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| No | 332BD1200X | Suppliers | Durable Medical Equipment & Medical Supplies | Dialysis Equipment & Supplies | |
| No | 335U00000X | Suppliers | Organ Procurement Organization |
