Provider Demographics
NPI:1841237021
Name:EUMANA HOME DIALYSIS INC
Entity Type:Organization
Organization Name:EUMANA HOME DIALYSIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-597-6467
Mailing Address - Street 1:1313 LA CONCHA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1809
Mailing Address - Country:US
Mailing Address - Phone:713-668-2744
Mailing Address - Fax:713-795-5959
Practice Address - Street 1:1313 LA CONCHA LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1809
Practice Address - Country:US
Practice Address - Phone:713-668-2744
Practice Address - Fax:713-795-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1242590001OtherDMERC
TX154141902Medicaid
TXHH6415OtherBCBS
TX531721OtherBCBS
TX452840Medicare Oscar/Certification