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General NPI Number Information
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NPI Number | 1922000587
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Entity Type | Organization
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Legal Business Name | THE DIALYSIS COTTAGE LLC
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 1902 HOSPITAL BLVD SUITE D
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City | GAINESVILLE
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State | TX
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Zip | 76240-2007
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Country | US
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Telephone | 940-612-1642
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Fax | 940-612-2360
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Provider Business Mailing Address
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Address Line | 1902 HOSPITAL BLVD SUITE D
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City | GAINESVILLE
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State | TX
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Zip | 76240-2007
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Country | US
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Telephone | 940-612-1642
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Fax | 940-612-2360
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TRISH A WHITE
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Credential | RN, CNN
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Telephone | 940-612-1642
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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 | 008551
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License Number State | TX
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