Provider Demographics
NPI:1073112660
Name:AQUA DIALYSIS NACOGDOCHES, LLC
Entity Type:Organization
Organization Name:AQUA DIALYSIS NACOGDOCHES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-721-2927
Mailing Address - Street 1:1237 SOUTHRIDGE CT STE 203
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4305
Mailing Address - Country:US
Mailing Address - Phone:682-429-4508
Mailing Address - Fax:346-214-6368
Practice Address - Street 1:3226 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2682
Practice Address - Country:US
Practice Address - Phone:936-559-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AQUA DIALYSIS LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment