Provider Demographics
NPI:1598168817
Name:BELLAIRE DIALYSIS
Entity type:Organization
Organization Name:BELLAIRE DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-634-9818
Mailing Address - Street 1:1400 CREEK WAY DR
Mailing Address - Street 2:SUITE # 231 A
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4072
Mailing Address - Country:US
Mailing Address - Phone:713-634-9818
Mailing Address - Fax:832-999-4370
Practice Address - Street 1:14412 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7520
Practice Address - Country:US
Practice Address - Phone:713-634-9818
Practice Address - Fax:832-999-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment