1134150204 NPI number — CAPITAL DIALYSIS OF TEXAS

Table of content: (NPI 1134150204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134150204 NPI number — CAPITAL DIALYSIS OF TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL DIALYSIS OF TEXAS
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:
SOUTHWOOD UNIT
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:
1134150204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 81546
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78708-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-977-0300
Provider Business Mailing Address Fax Number:
512-833-8488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 W BEN WHITE BLVD
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-383-0300
Provider Business Practice Location Address Fax Number:
512-448-2360
Provider Enumeration Date:
07/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NADER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
CHIEF OPERATONS OFFICER
Authorized Official Telephone Number:
512-826-2957

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  006874 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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