Provider Demographics
NPI:1912177072
Name:GREENVILLE DIALYSIS PARTNERS, LP
Entity Type:Organization
Organization Name:GREENVILLE DIALYSIS PARTNERS, LP
Other - Org Name:GREENVILLE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-408-1900
Mailing Address - Street 1:4211 JOE RAMSEY BLVD E
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7852
Mailing Address - Country:US
Mailing Address - Phone:903-408-1900
Mailing Address - Fax:903-408-5121
Practice Address - Street 1:4309 RIDGECREST ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6004
Practice Address - Country:US
Practice Address - Phone:903-408-1900
Practice Address - Fax:903-408-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment