MEDICARE: WEST PARK DIALYSIS CARE, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427143866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PARK DIALYSIS CARE, INC.

Provider Business Mailing Address
First Line	:	7001 CORPORATE DR
Second Line	:	STE. 227
City	:	HOUSTON
State	:	TX
Zip	:	77036-5192
Country	:	US
Telephone Number	:	713-917-0454
Fax Number	:	713-917-0909

Provider Business Practice Location Address
First Line	:	6400 SOUTHWEST FWY
Second Line	:	SUITE G
City	:	HOUSTON
State	:	TX
Zip	:	77074-2213
Country	:	US
Telephone Number	:	713-977-7877
Fax Number	:	713-977-7837

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PRAVIN B PATEL
Credential	:
Telephone Number	:	713-917-0454

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	05/11/2010

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