Provider Demographics
NPI:1447265202
Name:GARFIELD KIDNEY CENTER, LLC
Entity type:Organization
Organization Name:GARFIELD KIDNEY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-265-7301
Mailing Address - Street 1:3250 W FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-1509
Mailing Address - Country:US
Mailing Address - Phone:773-638-1160
Mailing Address - Fax:773-638-1449
Practice Address - Street 1:3250 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-1509
Practice Address - Country:US
Practice Address - Phone:773-638-1160
Practice Address - Fax:773-638-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-20
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
IL50339OtherBLUE CROSS
IL=========001Medicaid
IL142646Medicare Oscar/Certification