Basic Information
| Provider Information | |||||||||
| NPI: | 1912079658 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDNEY SOLUTIONS OF TEXAS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOUSTON HOME DIALYSIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2626 SOUTH LOOP W | ||||||||
| Address2: | #520 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136617733 | ||||||||
| FaxNumber: | 7136617755 | ||||||||
| Practice Location | |||||||||
| Address1: | 2626 SOUTH LOOP W | ||||||||
| Address2: | #520 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136617733 | ||||||||
| FaxNumber: | 7136617755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | EASON | ||||||||
| AuthorizedOfficialFirstName: | RACHEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7136617733 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 008321 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.