Provider Demographics
NPI:1831288646
Name:WOODVILLE DIALYSIS CENTER LLP
Entity Type:Organization
Organization Name:WOODVILLE DIALYSIS CENTER LLP
Other - Org Name:
Other - Org Type:
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 1:712 W BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-5132
Mailing Address - Country:US
Mailing Address - Phone:409-331-1500
Mailing Address - Fax:409-331-1501
Practice Address - Street 1:712 W. BLUFF ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-5132
Practice Address - Country:US
Practice Address - Phone:409-331-1500
Practice Address - Fax:409-331-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
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
TX185043002Medicaid
TX185043002Medicaid