MEDICARE: TEXOMA DIALYSIS 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1144611278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXOMA DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-341-6793
Fax Number	:	866-409-3229

Provider Business Practice Location Address
First Line	:	7700 AFFINITY DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3566
Country	:	US
Telephone Number	:	513-521-0981
Fax Number	:	513-521-1566

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JAMES K HILGER
Credential	:
Telephone Number	:	253-733-4500

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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