Provider Demographics
NPI:1679684567
Name:JASPER-ARA DIALYSIS L.L.P.
Entity Type:Organization
Organization Name:JASPER-ARA DIALYSIS L.L.P.
Other - Org Name:KIDNEY CENTER OF JASPER
Other - Org Type:Doing Business As
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 1:930 MARVIN HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4752
Mailing Address - Country:US
Mailing Address - Phone:409-384-4200
Mailing Address - Fax:409-384-4255
Practice Address - Street 1:930 MARVIN HANCOCK DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4752
Practice Address - Country:US
Practice Address - Phone:409-384-4200
Practice Address - Fax:409-384-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
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
TX145502402Medicaid
TX145502403Medicaid
452830Medicare Oscar/Certification