Provider Demographics
NPI:1386645026
Name:QUALITY DIALYSIS TWO LP
Entity Type:Organization
Organization Name:QUALITY DIALYSIS TWO LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-491-4009
Mailing Address - Street 1:13311 PIKE RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5111
Mailing Address - Country:US
Mailing Address - Phone:281-491-4009
Mailing Address - Fax:866-557-4844
Practice Address - Street 1:13311 PIKE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5111
Practice Address - Country:US
Practice Address - Phone:281-491-4009
Practice Address - Fax:866-557-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007039261QE0700X
TX261QH0100X
261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094322701Medicaid
TX019456OtherDMEPOS ACCREDIDIATION CERTIFICATION
TX007039OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES REGULATORY UNIT-ESRD FACILITY
TX094322701Medicaid