Provider Demographics
NPI:1992873970
Name:TEXAS CITY DIALYSIS L.L.P.
Entity type:Organization
Organization Name:TEXAS CITY DIALYSIS L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSOUAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-948-3900
Mailing Address - Street 1:3557 PALMER HWY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-6513
Mailing Address - Country:US
Mailing Address - Phone:409-948-9300
Mailing Address - Fax:409-947-9405
Practice Address - Street 1:3557 PALMER HWY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-6513
Practice Address - Country:US
Practice Address - Phone:409-948-9300
Practice Address - Fax:409-947-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-01-08
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
TX094304501Medicaid
G55874Medicare UPIN
TX094304501Medicaid