MEDICARE: DIALYSPA CONTRACT SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1023371291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSPA CONTRACT SERVICES, LLC

Provider Business Mailing Address
First Line	:	2453 S. BRAESWOOD BLVD, STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-218-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2453 S. BRAESWOOD BLVD, STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-218-6500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFFREY KALINA
Credential	:	MD
Telephone Number	:	713-218-6500

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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