Healthcare Provider Details

I. General information

NPI: 1538700729
Provider Name (Legal Business Name): SNG - WESTOVER HILLS DIALYSIS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9443 DUGAS DR
SAN ANTONIO TX
78245
US

IV. Provider business mailing address

1000 W CANNON ST
FORT WORTH TX
76104-3029
US

V. Phone/Fax

Practice location:
  • Phone: 682-253-5300
  • Fax:
Mailing address:
  • Phone: 586-682-5300
  • Fax: 844-448-5486

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: PONNIAH S. SANKARAPANDIAN
Title or Position: MANAGER
Credential: MD
Phone: 817-725-7900