Healthcare Provider Details

I. General information

NPI: 1124140462
Provider Name (Legal Business Name): UREA DIALYSIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 MURPHY RD STE 120
STAFFORD TX
77477-3970
US

IV. Provider business mailing address

13000 MURPHY RD STE 120
STAFFORD TX
77477-3970
US

V. Phone/Fax

Practice location:
  • Phone: 281-313-0449
  • Fax: 713-981-7774
Mailing address:
  • Phone: 281-313-0449
  • Fax: 713-981-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberH5209
License Number StateTX

VIII. Authorized Official

Name: MR. JOE KIMBLE
Title or Position: CEO
Credential:
Phone: 281-313-0449