1487882866 NPI number — BAY CITY DIALYSIS CENTER LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487882866 NPI number — BAY CITY DIALYSIS CENTER LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY CITY DIALYSIS CENTER LLP
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:
BAY CITY REGIONAL DIALYSIS 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:
1487882866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MEDICAL CENTER CT
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77414-4733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-323-0818
Provider Business Mailing Address Fax Number:
979-323-0814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77414-4733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-323-0818
Provider Business Practice Location Address Fax Number:
979-323-0814
Provider Enumeration Date:
06/24/2009

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: 280525101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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