Provider Demographics
NPI:1720111958
Name:NORTH TEXAS DIALYSIS INC.
Entity Type:Organization
Organization Name:NORTH TEXAS DIALYSIS INC.
Other - Org Name:LEWISVILLE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:HILTON
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-436-7211
Mailing Address - Street 1:1600 WATERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6014
Mailing Address - Country:US
Mailing Address - Phone:972-436-7211
Mailing Address - Fax:972-436-9273
Practice Address - Street 1:1600 WATERS RIDGE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-6014
Practice Address - Country:US
Practice Address - Phone:972-436-7211
Practice Address - Fax:972-436-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008002261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452648Medicare ID - Type UnspecifiedPROVIDER NUMBER FOR CMS