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NPI Code Detail

MEDICARE: WHARTON DIALYSIS, INC.

MEDICARE: WHARTON DIALYSIS, INC.
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1215039490
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHARTON DIALYSIS, INC.
Provider Business Mailing Address
First Line : 1450 HIGHWAY 59 LOOP N
Second Line :
City : WHARTON
State : TX
Zip : 77488-7807
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1450 HIGHWAY 59 LOOP N
Second Line :
City : WHARTON
State : TX
Zip : 77488-7807
Country : US
Telephone Number : 979-532-3757
Fax Number :
Authorized Official
Title or Position : TREASURER
Name : MARK FAWCETT
Credential :
Telephone Number : 781-402-9000
Provider Enumeration Date : 09/01/2006
Last Update Date : 08/29/2008

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