Provider Demographics
NPI:1811980626
Name:INDEPENDENT DIALYSIS SERVICES, INC
Entity type:Organization
Organization Name:INDEPENDENT DIALYSIS SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-914-3625
Mailing Address - Street 1:2900 ELYSIAN FIELDS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3625
Mailing Address - Country:US
Mailing Address - Phone:504-947-3625
Mailing Address - Fax:504-947-3675
Practice Address - Street 1:2900 ELYSIAN FIELDS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3625
Practice Address - Country:US
Practice Address - Phone:504-947-3625
Practice Address - Fax:504-947-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
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
LA1436356Medicaid
LA30345OtherBLUE CROSS PROVIDER NUMBE
LA192639Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER