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General NPI Number Information
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NPI Number | 1356733588
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Entity Type | Organization
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Legal Business Name | I-DIALYSIS, LLC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 8760 US HWY 59 S
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City | NACOGDOCHES
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State | TX
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Zip | 75964-3158
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Country | US
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Telephone | 936-715-0777
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Fax | 936-715-0779
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Provider Business Mailing Address
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Address Line | 8760 US HWY 59 S
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City | NACOGDOCHES
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State | TX
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Zip | 75964-3158
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Country | US
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Telephone | 936-715-0777
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Fax | 936-715-0779
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Authorized Official
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Title or Position | MANAGER
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Name | DR. IMRAN NAZEER
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Credential | MD
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Telephone | 936-715-0777
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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 | TX
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