1245346048 NPI number — BEAUMONT-ARA DIALYSIS L.L.P.

Table of content: (NPI 1245346048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245346048 NPI number — BEAUMONT-ARA DIALYSIS L.L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAUMONT-ARA DIALYSIS L.L.P.
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:
BEAUMONT KIDNEY CENTER
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:
1245346048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1085 S 23RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77707-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-840-2020
Provider Business Mailing Address Fax Number:
409-840-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1085 S 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77707-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-840-2020
Provider Business Practice Location Address Fax Number:
409-840-2033
Provider Enumeration Date:
08/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRADY
Authorized Official First Name:
SARA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
CHIEF NURSING OFFICER
Authorized Official Telephone Number:
208-371-7878

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: 146527003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".