=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528226867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1960 DIALYSIS CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 FM 1960 RD E SUITE 104
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77073-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-443-2209
-----------------------------------------------------
Fax | 713-456-7924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 FM 1960 RD E SUITE 104
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77073-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-443-2209
-----------------------------------------------------
Fax | 713-456-7924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PINAKIN R PATEL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-464-0236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------