1083660617 NPI number — EL PASO KIDNEY CENTER EAST LTD

Table of content: (NPI 1083660617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083660617 NPI number — EL PASO KIDNEY CENTER EAST LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL PASO KIDNEY CENTER EAST LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
U.S. RENAL CARE EAST EL PASO DIALYSIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083660617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 CHURCH ST
Provider Second Line Business Mailing Address:
SUITE 1900
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37219-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-234-1188
Provider Business Mailing Address Fax Number:
615-234-9526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10737 GATEWAY BLVD W
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79935-4920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-590-8334
Provider Business Practice Location Address Fax Number:
915-590-9051
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1910234-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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