Healthcare Provider Details

I. General information

NPI: 1750642385
Provider Name (Legal Business Name): SNG - NORTHWEST DIALYSIS CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7112 STUEBNER AIRLINE RD
HOUSTON TX
77091-2408
US

IV. Provider business mailing address

1000 W CANNON ST
FORT WORTH TX
76104-3029
US

V. Phone/Fax

Practice location:
  • Phone: 713-490-7382
  • Fax: 713-490-7389
Mailing address:
  • Phone: 817-725-7900
  • Fax: 682-207-1030

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 State

VIII. Authorized Official

Name: KINAM C. MARTIN
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 817-725-7900