MEDICARE: GREATER IRVING I REGIONAL 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

General Provider Information

NPI Number	:	1427414630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER IRVING I REGIONAL DIALYSIS CENTER LLC

Provider Business Mailing Address
First Line	:	1950 NE GREEN OAKS BLVD
Second Line	:	SUITE 190
City	:	ARLINGTON
State	:	TX
Zip	:	76006-3287
Country	:	US
Telephone Number	:	817-460-0510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 NE GREEN OAKS BLVD
Second Line	:	SUITE 190
City	:	ARLINGTON
State	:	TX
Zip	:	76006-3287
Country	:	US
Telephone Number	:	817-460-0510
Fax Number	:

Authorized Official
Title or Position	:	CHIEF NURSING OFFICER
Name	:	SARA ANNE BRADY
Credential	:
Telephone Number	:	208-371-7878

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	06/03/2026

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