MEDICARE: S.A.K.D.C., 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

General Provider Information

NPI Number	:	1467564344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S.A.K.D.C., INC.

Provider Business Mailing Address
First Line	:	803 CASTROVILLE ROAD
Second Line	:	SUITE 410
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-3148
Country	:	US
Telephone Number	:	210-435-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 CASTROVILLE ROAD
Second Line	:	SUITE 410
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-3148
Country	:	US
Telephone Number	:	210-435-2100
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK FAWCETT
Credential	:
Telephone Number	:	781-699-9303

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/17/2013

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