Provider Demographics
NPI:1316069701
Name:GRAYSON DIALYSIS AND KIDNEY CENTER
Entity type:Organization
Organization Name:GRAYSON DIALYSIS AND KIDNEY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-654-8074
Mailing Address - Street 1:286 HIGHWAY 1947
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143
Mailing Address - Country:US
Mailing Address - Phone:606-474-2310
Mailing Address - Fax:606-474-0569
Practice Address - Street 1:1656 13TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3829
Practice Address - Country:US
Practice Address - Phone:304-529-2090
Practice Address - Fax:304-522-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
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
WV3810006539Medicaid
KY000000494978OtherANTHEM BCBS PROV NUMBER
WV3810006539Medicaid
KY000000494978OtherANTHEM BCBS PROV NUMBER