MEDICARE: DOWNTOWN DIALYSIS 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	:	1629424726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNTOWN DIALYSIS LLC

Provider Business Mailing Address
First Line	:	2400 DALLAS PKWY
Second Line	:	STE 350
City	:	PLANO
State	:	TX
Zip	:	75093-4370
Country	:	US
Telephone Number	:	214-736-2700
Fax Number	:	214-736-2701

Provider Business Practice Location Address
First Line	:	2511 W 3RD ST STE 120
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1946
Country	:	US
Telephone Number	:	213-487-7730
Fax Number	:	213-487-7760

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	THOMAS L WEINBERG
Credential	:
Telephone Number	:	214-736-2730

Provider Enumeration Date	:	05/06/2016
Last Update Date	:	02/23/2024

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