Provider Demographics
NPI:1821100793
Name:STAT DIALYSIS CORPORATION
Entity Type:Organization
Organization Name:STAT DIALYSIS CORPORATION
Other - Org Name:RCG DOWNTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-402-9000
Mailing Address - Street 1:1914 CAROLINE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1914 CAROLINE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8210
Practice Address - Country:US
Practice Address - Phone:713-951-9328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
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
452554Medicare ID - Type Unspecified