Provider Demographics
NPI:1093706442
Name:COUNTY OF YOAKUM
Entity Type:Organization
Organization Name:COUNTY OF YOAKUM
Other - Org Name:DIALYSIS SERVICES OF WEST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-592-2121
Mailing Address - Street 1:500 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-2706
Mailing Address - Country:US
Mailing Address - Phone:806-592-2090
Mailing Address - Fax:806-592-2341
Practice Address - Street 1:500 W 5TH ST
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-2706
Practice Address - Country:US
Practice Address - Phone:806-592-2090
Practice Address - Fax:806-592-2341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF YOAKUM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-03
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008086261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168181901Medicaid
TX168181901Medicaid