MEDICARE: SNG - SOHUM HOUSTON 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	110291	OTHER	TX	FACILITY LICENSE

General Provider Information

NPI Number	:	1598006835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNG - SOHUM HOUSTON 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	:	1900 NORTH LOOP W
Second Line	:	STE 200
City	:	HOUSTON
State	:	TX
Zip	:	77018-8117
Country	:	US
Telephone Number	:	713-773-1717
Fax Number	:	713-773-1716

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

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	07/21/2022

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