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General NPI Number Information
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NPI Number | 1235596446
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Entity Type | Organization
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Legal Business Name | GRAPEVINE KIDNEY CENTER LLC
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 1270 WILLIAM D TATE AVE SUITE 300
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City | GRAPEVINE
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State | TX
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Zip | 76051-4098
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Country | US
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Telephone | 817-421-6326
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Fax | 817-421-6827
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Provider Business Mailing Address
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Address Line | 1270 WILLIAM D TATE AVE SUITE 300
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City | GRAPEVINE
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State | TX
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Zip | 76051-4098
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Country | US
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Telephone | 817-421-6326
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Fax | 817-421-6827
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Authorized Official
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Title or Position | CHIEF NURSING OFFICER
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Name | SARA ANNE BRADY
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Credential |
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Telephone | 208-371-7878
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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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