MEDICARE: COMPLETE DIALYSIS CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639597552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE DIALYSIS CARE LLC

Provider Business Mailing Address
First Line	:	607 EAST 7TH STREET
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4509
Country	:	US
Telephone Number	:	432-332-1632
Fax Number	:	432-332-1633

Provider Business Practice Location Address
First Line	:	607 EAST 7TH STREET
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4509
Country	:	US
Telephone Number	:	432-332-1632
Fax Number	:	432-332-1633

Authorized Official
Title or Position	:	CHIEF NURSING OFFICER
Name	:	SARA ANNE BRADY
Credential	:
Telephone Number	:	208-371-7878

Provider Enumeration Date	:	03/29/2014
Last Update Date	:	05/19/2026

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