Provider Demographics
NPI:1821029273
Name:CAPITAL DIALYSIS OF TEXAS
Entity Type:Organization
Organization Name:CAPITAL DIALYSIS OF TEXAS
Other - Org Name:MANOR UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-826-2957
Mailing Address - Street 1:PO BOX 81546
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78708-1546
Mailing Address - Country:US
Mailing Address - Phone:512-927-0300
Mailing Address - Fax:512-933-9422
Practice Address - Street 1:3607 MANOR RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-5816
Practice Address - Country:US
Practice Address - Phone:512-927-0300
Practice Address - Fax:512-933-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006778261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX006778OtherTX DEPART. STATE HEALTH
TX452789Medicare ID - Type UnspecifiedMEDICARE ID