Provider Demographics
NPI:1306000849
Name:STAFFORD DIALYSIS RENAL INC.
Entity Type:Organization
Organization Name:STAFFORD DIALYSIS RENAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-298-3658
Mailing Address - Street 1:12220 MURPHY RD
Mailing Address - Street 2:SUTIE R
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2410
Mailing Address - Country:US
Mailing Address - Phone:713-545-6506
Mailing Address - Fax:
Practice Address - Street 1:12220 MURPHY RD
Practice Address - Street 2:SUITE R
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2410
Practice Address - Country:US
Practice Address - Phone:713-545-6506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment