Healthcare Provider Details

I. General information

NPI: 1346250446
Provider Name (Legal Business Name): DIALYSIS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 8TH AVE
FORT WORTH TX
76110-1812
US

IV. Provider business mailing address

2221 8TH AVE
FORT WORTH TX
76110-1812
US

V. Phone/Fax

Practice location:
  • Phone: 817-336-5060
  • Fax: 817-336-1744
Mailing address:
  • Phone: 817-336-5060
  • Fax: 817-336-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE M MITZMAN
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 817-289-7202