Provider Demographics
NPI:1982887907
Name:EXCEL DIALYSIS, LLC
Entity Type:Organization
Organization Name:EXCEL DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:IKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-777-4699
Mailing Address - Street 1:7500 BEECHNUT ST STE 152
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-4310
Mailing Address - Country:US
Mailing Address - Phone:713-777-4699
Mailing Address - Fax:
Practice Address - Street 1:7500 BEECHNUT ST STE 152
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4310
Practice Address - Country:US
Practice Address - Phone:713-777-4699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment