1164817664 NPI number — INNOVATIVE DIALYSIS SOLUTIONS AT HOME, PLLC

Table of content: (NPI 1164817664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164817664 NPI number — INNOVATIVE DIALYSIS SOLUTIONS AT HOME, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE DIALYSIS SOLUTIONS AT HOME, PLLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1164817664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 S LAREDO ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78204-3211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2795 BULVERDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BULVERDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78163-2195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-714-9242
Provider Business Practice Location Address Fax Number:
830-714-7467
Provider Enumeration Date:
04/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SZEWC
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
NEPHROLOGIST
Authorized Official Telephone Number:
210-277-1418

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: 3929473-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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