Provider Demographics
NPI:1336448489
Name:SOUTH PRICE DIALYSIS LLC
Entity type:Organization
Organization Name:SOUTH PRICE DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANDASIVAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-548-2242
Mailing Address - Street 1:64 S PRICE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2459
Mailing Address - Country:US
Mailing Address - Phone:956-548-2242
Mailing Address - Fax:956-548-2262
Practice Address - Street 1:64 S PRICE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2459
Practice Address - Country:US
Practice Address - Phone:956-548-2242
Practice Address - Fax:956-548-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment