Provider Demographics
NPI:1801163266
Name:TERRELL DIALYSIS CENTER, LLC
Entity type:Organization
Organization Name:TERRELL DIALYSIS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:530 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5703
Mailing Address - Country:US
Mailing Address - Phone:214-703-3781
Mailing Address - Fax:214-703-0564
Practice Address - Street 1:530 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5703
Practice Address - Country:US
Practice Address - Phone:214-703-3781
Practice Address - Fax:214-703-0564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
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
672587Medicare Oscar/Certification