1992938443 NPI number — HUMBLE DIALYSIS, LP

Table of content: (NPI 1992938443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992938443 NPI number — HUMBLE DIALYSIS, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMBLE DIALYSIS, LP
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:
Provider Other Organization Name Type Code:
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:
1992938443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19502 MCKAY DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77338-5720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-540-4313
Provider Business Mailing Address Fax Number:
281-540-4185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19502 MCKAY DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-540-4313
Provider Business Practice Location Address Fax Number:
281-540-4185
Provider Enumeration Date:
09/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF NURSING/ FACILITY ADMIN
Authorized Official Telephone Number:
281-540-4313

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  110007 , 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)

  • Identifier: 337172601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: N1001828 . This is a "WELLCARE PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com