Provider Demographics
NPI:1346352226
Name:STAT DIALYSIS CORPORATION
Entity Type:Organization
Organization Name:STAT DIALYSIS CORPORATION
Other - Org Name:MISSION KIDNEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:1203 ST CLAIRE BLVD STE 10B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-9199
Mailing Address - Country:US
Mailing Address - Phone:956-391-1940
Mailing Address - Fax:956-529-1506
Practice Address - Street 1:1203 ST CLAIRE BLVD STE 10B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9199
Practice Address - Country:US
Practice Address - Phone:956-391-1940
Practice Address - Fax:956-529-1506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2023-10-16
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
452714Medicare ID - Type Unspecified