Basic Information
| Provider Information | |||||||||
| NPI: | 1073705505 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOUSTON DIALYSIS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8800 BISSONNET ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770742435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137731717 | ||||||||
| FaxNumber: | 7137731716 | ||||||||
| Practice Location | |||||||||
| Address1: | 8800 BISSONNET ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770742435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137731717 | ||||||||
| FaxNumber: | 7137731716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2007 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | ELHAJ | ||||||||
| AuthorizedOfficialFirstName: | WISAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7137731717 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.