Provider Demographics
NPI:1093082455
Name:TERRELL DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:TERRELL DIALYSIS CENTER, LLC
Other - Org Name:RENAL CARE GROUP IRVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:1625 N STORY RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-1945
Mailing Address - Country:US
Mailing Address - Phone:972-871-8282
Mailing Address - Fax:972-871-0305
Practice Address - Street 1:1625 N STORY RD
Practice Address - Street 2:SUITE 140
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-1945
Practice Address - Country:US
Practice Address - Phone:972-871-8282
Practice Address - Fax:972-871-0305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
452561Medicare Oscar/Certification