MEDICARE: CAPITAL DIALYSIS OF TEXAS

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	006874	TX

General Provider Information

NPI Number	:	1134150204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL DIALYSIS OF TEXAS

Provider Business Mailing Address
First Line	:	PO BOX 81546
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78708-1546
Country	:	US
Telephone Number	:	512-977-0300
Fax Number	:	512-833-8488

Provider Business Practice Location Address
First Line	:	1701 W BEN WHITE BLVD
Second Line	:	SUITE 180
City	:	AUSTIN
State	:	TX
Zip	:	78704-7667
Country	:	US
Telephone Number	:	512-383-0300
Fax Number	:	512-448-2360

Authorized Official
Title or Position	:	CHIEF OPERATONS OFFICER
Name	:	DR. PAUL CHARLES NADER
Credential	:	MD
Telephone Number	:	512-826-2957

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/22/2020

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