Healthcare Provider Details

I. General information

NPI: 1740725019
Provider Name (Legal Business Name): DIALYSPA VI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 WEST LOOP S STE 190
BELLAIRE TX
77401-4524
US

IV. Provider business mailing address

PO BOX 128
BELLAIRE TX
77402-0128
US

V. Phone/Fax

Practice location:
  • Phone: 281-833-3330
  • Fax: 281-833-3327
Mailing address:
  • Phone: 281-833-3330
  • Fax: 281-833-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: JEFFERY KALINA
Title or Position: CEO
Credential: MD
Phone: 713-218-6500