Provider Demographics
NPI:1801064241
Name:NEW CENTURY DIALYSIS CENTER OF JASPER, L.L.C.
Entity type:Organization
Organization Name:NEW CENTURY DIALYSIS CENTER OF JASPER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUNG-MAN
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-384-2711
Mailing Address - Street 1:PO BOX 21026
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-1026
Mailing Address - Country:US
Mailing Address - Phone:409-384-2711
Mailing Address - Fax:
Practice Address - Street 1:2014 S WHEELER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5624
Practice Address - Country:US
Practice Address - Phone:409-384-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207029401Medicaid
TX672610Medicare Oscar/Certification