Provider Demographics
NPI:1194358069
Name:LITTLE YORK DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:LITTLE YORK DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PINAKIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-464-0236
Mailing Address - Street 1:1170 BLALOCK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7421
Mailing Address - Country:US
Mailing Address - Phone:713-464-0236
Mailing Address - Fax:713-456-3515
Practice Address - Street 1:2711 LITTLE YORK RD STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-3442
Practice Address - Country:US
Practice Address - Phone:832-831-6066
Practice Address - Fax:713-456-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742592OtherMEDICARE