MEDICARE: DIALYSPA MEDICAL 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	110027	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	672678	OTHER	TX	MEDICARE PTAN

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	:	1518294826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSPA MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77402-0128
Country	:	US
Telephone Number	:	281-833-3330
Fax Number	:	281-833-3323

Provider Business Practice Location Address
First Line	:	2453 S BRAESWOOD BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4305
Country	:	US
Telephone Number	:	713-218-6500
Fax Number	:	713-218-6507

Authorized Official
Title or Position	:	CEO
Name	:	JEFFREY E KALINA
Credential	:	MD
Telephone Number	:	713-218-6500

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	08/11/2020

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Directions to “DIALYSPA MEDICAL CENTER LLC ” Practice Location

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