Provider Demographics
NPI:1558485052
Name:MOBILE DIALYSIS SOLUTIONS, INC
Entity type:Organization
Organization Name:MOBILE DIALYSIS SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:WAKLATSI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-389-7639
Mailing Address - Street 1:6488 GLENWAY AVE STE N
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5223
Mailing Address - Country:US
Mailing Address - Phone:513-389-7639
Mailing Address - Fax:513-389-7633
Practice Address - Street 1:6488 GLENWAY AVE STE N
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5223
Practice Address - Country:US
Practice Address - Phone:513-389-7639
Practice Address - Fax:513-389-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16171642472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty