Provider Demographics
NPI:1104255645
Name:MATAGORDA DIALYSIS CARE LLP
Entity type:Organization
Organization Name:MATAGORDA DIALYSIS CARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:1105 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3538
Mailing Address - Country:US
Mailing Address - Phone:979-245-0099
Mailing Address - Fax:979-245-6435
Practice Address - Street 1:1105 AVENUE H
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3538
Practice Address - Country:US
Practice Address - Phone:979-245-0099
Practice Address - Fax:979-245-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2023-01-11
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
TX335873101Medicaid
TX335873101Medicaid