MEDICARE: NORTH SHEPHERD DIALYSIS CENTER, 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	008205	TX

General Provider Information

NPI Number	:	1376846428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHEPHERD DIALYSIS CENTER, LLC

Provider Business Mailing Address
First Line	:	8700 S GESSNER DR STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2916
Country	:	US
Telephone Number	:	979-864-4330
Fax Number	:	979-864-3560

Provider Business Practice Location Address
First Line	:	7272 N SHEPHERD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-2435
Country	:	US
Telephone Number	:	979-864-4330
Fax Number	:	979-864-3560

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LORI TIMMONS
Credential	:	RN, BSN
Telephone Number	:	979-864-4330

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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