Provider Demographics
NPI:1104336650
Name:DIAMOND DIALYSIS - STAFFORD TEXAS LLC
Entity type:Organization
Organization Name:DIAMOND DIALYSIS - STAFFORD TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-785-8242
Mailing Address - Street 1:3623 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE #100
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477
Mailing Address - Country:US
Mailing Address - Phone:832-987-1793
Mailing Address - Fax:832-987-1873
Practice Address - Street 1:3623 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477
Practice Address - Country:US
Practice Address - Phone:832-987-1793
Practice Address - Fax:832-987-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment