Provider Demographics
NPI:1427143866
Name:WEST PARK DIALYSIS CARE, INC.
Entity type:Organization
Organization Name:WEST PARK DIALYSIS CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-917-0454
Mailing Address - Street 1:7001 CORPORATE DR
Mailing Address - Street 2:STE. 227
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5192
Mailing Address - Country:US
Mailing Address - Phone:713-917-0454
Mailing Address - Fax:713-917-0909
Practice Address - Street 1:6400 SOUTHWEST FWY
Practice Address - Street 2:SUITE G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2213
Practice Address - Country:US
Practice Address - Phone:713-977-7877
Practice Address - Fax:713-977-7837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-05-11
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
TX210085101Medicaid
TX210085101Medicaid