Provider Demographics
NPI: | 1144611278 |
---|---|
Name: | TEXOMA DIALYSIS LLC |
Entity Type: | Organization |
Organization Name: | TEXOMA DIALYSIS LLC |
Other - Org Name: | AFFINITY PLACE DIALYSIS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF ACCOUNTING OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | HILGER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 253-733-4500 |
Mailing Address - Street 1: | 5200 VIRGINIA WAY |
Mailing Address - Street 2: | L&C DEPT |
Mailing Address - City: | BRENTWOOD |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37027-7569 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-341-6793 |
Mailing Address - Fax: | 866-409-3229 |
Practice Address - Street 1: | 7700 AFFINITY DR |
Practice Address - Street 2: | |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45231-3566 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-521-0981 |
Practice Address - Fax: | 513-521-1566 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-02-11 |
Last Update Date: | 2015-02-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QE0700X | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |