Provider Demographics
NPI:1295058709
Name:NORTHWEST DIALYIS CENTER,LLC
Entity type:Organization
Organization Name:NORTHWEST DIALYIS CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTAK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:713-490-7382
Mailing Address - Street 1:7112 STUEBNER AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-2408
Mailing Address - Country:US
Mailing Address - Phone:713-490-7382
Mailing Address - Fax:713-490-7389
Practice Address - Street 1:7112 STUEBNER AIRLINE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-2408
Practice Address - Country:US
Practice Address - Phone:713-490-7382
Practice Address - Fax:713-490-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110031261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment