Provider Demographics
NPI:1942544408
Name:DIALYSPA II LLC
Entity Type:Organization
Organization Name:DIALYSPA II LLC
Other - Org Name:DIALYSPA VINTAGE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KALINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-218-6500
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:102 VINTAGE PARK BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4079
Practice Address - Country:US
Practice Address - Phone:713-218-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110174261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX672763Medicare PIN