Provider Demographics
NPI:1316914062
Name:INDEPENDENT DIALYSIS FOUNDATION
Entity type:Organization
Organization Name:INDEPENDENT DIALYSIS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INFORMATION SYSTEMS
Authorized Official - Prefix:MR
Authorized Official - First Name:ZEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-468-0900
Mailing Address - Street 1:840 HOLLINS ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1024
Mailing Address - Country:US
Mailing Address - Phone:410-468-0900
Mailing Address - Fax:410-468-0911
Practice Address - Street 1:840 HOLLINS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1024
Practice Address - Country:US
Practice Address - Phone:410-468-0900
Practice Address - Fax:410-468-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
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
MD215143OtherIDF-PARKVIEW CENTER
MD215143OtherIDF-CHESTNUT SQUARE
WV0005759000Medicaid
PA01689292Medicaid
MD212548Medicare ID - Type UnspecifiedIDF-ALLEGANY CENTER
MD212513Medicare ID - Type UnspecifiedIDF-CHESTNUT SQUARE
MD212549Medicare ID - Type UnspecifiedIDF-CALVERT CENTER
PA01689292Medicaid
MD215143OtherIDF-PARKVIEW CENTER
MD212544Medicare ID - Type UnspecifiedIDF-ARUNDEL CENTER
MD212582Medicare ID - Type UnspecifiedIDF-DEATON CENTER
MD212560Medicare ID - Type UnspecifiedIDF-TRINITY CENTER