Provider Demographics
NPI:1598133951
Name:SOUTHWEST ACUTE MOBILE DIALYSIS
Entity Type:Organization
Organization Name:SOUTHWEST ACUTE MOBILE DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMACHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-692-0518
Mailing Address - Street 1:212 E CROSSTIMBERS ST STE 130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-4409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 E CROSSTIMBERS ST STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-4409
Practice Address - Country:US
Practice Address - Phone:713-692-0518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty