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General NPI Number Information
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NPI Number | 1174877138
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Entity Type | Organization
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Legal Business Name | SNG - ST. TAMMANY DIALYSIS CENTER LP
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 397 HIGHWAY 21 STE 602
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City | MADISONVILLE
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State | LA
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Zip | 70447-3407
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Country | US
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Telephone | 985-792-5334
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Fax | 985-792-5234
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Provider Business Mailing Address
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Address Line | 1000 W CANNON ST
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City | FORT WORTH
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State | TX
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Zip | 76104-3029
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Country | US
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Telephone | 817-725-7900
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Fax | 682-207-1030
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | KINAM C. MARTIN
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Credential |
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Telephone | 817-725-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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