Provider Demographics
NPI:1326451915
Name:REGIONAL DIALYSIS CENTER OF MESQUITE LLC
Entity Type:Organization
Organization Name:REGIONAL DIALYSIS CENTER OF MESQUITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:1650 REPUBLIC PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6920
Mailing Address - Country:US
Mailing Address - Phone:972-613-4715
Mailing Address - Fax:972-613-4719
Practice Address - Street 1:1650 REPUBLIC PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6920
Practice Address - Country:US
Practice Address - Phone:972-613-4715
Practice Address - Fax:972-613-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2023-01-10
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
TX365049101Medicaid
TX672793Medicare Oscar/Certification