Provider Demographics
NPI:1972509859
Name:BEECHNUT DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:BEECHNUT DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-265-2341
Mailing Address - Street 1:PO BOX 720540
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77272-0540
Mailing Address - Country:US
Mailing Address - Phone:713-772-5228
Mailing Address - Fax:713-490-2344
Practice Address - Street 1:8325 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-6853
Practice Address - Country:US
Practice Address - Phone:713-772-5228
Practice Address - Fax:713-490-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00800042472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163949402Medicaid