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General NPI Number Information
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NPI Number | 1952778011
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Entity Type | Organization
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Legal Business Name | DIAMOND DIALYSIS - MISSOURI CITY LLC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 5603 HIGHWAY 6
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City | MISSOURI CITY
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State | TX
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Zip | 77459-4189
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Country | US
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Telephone | 832-987-1353
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Fax |
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Provider Business Mailing Address
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Address Line | 5603 HIGHWAY 6
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City | MISSOURI CITY
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State | TX
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Zip | 77459-4189
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Country | US
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Telephone | 832-987-1353
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Fax |
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | MARION WILSON
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Credential |
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Telephone | 713-294-7553
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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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