MEDICARE: SNG - SANDCASTLE DIALYSIS CENTER LP

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	110093	OTHER	TX	FACILITY LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518289594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNG - SANDCASTLE DIALYSIS CENTER LP

Provider Business Mailing Address
First Line	:	1000 W CANNON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3029
Country	:	US
Telephone Number	:	817-725-7900
Fax Number	:	682-207-1030

Provider Business Practice Location Address
First Line	:	8900 EMMETT F LOWRY EXPY
Second Line	:	STE 201
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-9119
Country	:	US
Telephone Number	:	409-933-0406
Fax Number	:	409-933-0503

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	KINAM C. MARTIN
Credential	:
Telephone Number	:	817-725-7900

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	07/21/2022

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Directions to “SNG - SANDCASTLE DIALYSIS CENTER LP ” Practice Location

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