1952413007 NPI number — RENAL CENTER OF MIDLAND-ODESSA, LP, LLLP

Table of content: (NPI 1952413007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952413007 NPI number — RENAL CENTER OF MIDLAND-ODESSA, LP, LLLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL CENTER OF MIDLAND-ODESSA, LP, LLLP
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:
1952413007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1626 COLE BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-384-4000
Provider Business Mailing Address Fax Number:
303-273-5991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4241 TANGLEWOOD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79762-5988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-366-3940
Provider Business Practice Location Address Fax Number:
432-336-6393
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHATFIELD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
303-384-4090

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  008267 , 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)





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