Provider Demographics
NPI:1457028201
Name:SPECTRUM KIDNEY CARE LLC
Entity Type:Organization
Organization Name:SPECTRUM KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:936-443-5443
Mailing Address - Street 1:PO BOX 90233
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77290-0233
Mailing Address - Country:US
Mailing Address - Phone:936-443-5443
Mailing Address - Fax:
Practice Address - Street 1:1444 LINDBERG DR # 100
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8056
Practice Address - Country:US
Practice Address - Phone:936-443-5443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM KIDNEY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment