MEDICARE: QUALITY DIALYSIS ONE, 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	251E00000X	Home Health Agency	005985	TX
2	253Z00000X	In Home Supportive Care Agency	005985	TX
3	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	005985	TX
4	332BD1200X	Dialysis Equipment & Supplies (DME)	1001352	TX
5	251F00000X	Home Infusion Agency	005985	TX

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	1001352	OTHER	TX	TEXAS DEPARTMENT OF STATE HEALTH SERVICES-DEVICE DISTRIBUTOR
3	019455	OTHER	TX	DMEPOS ACCREDIDIATION CERTIFICATION
4	005985	OTHER	TX	TEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES HOME & SUPPORT SRVC AGENCY

General Provider Information

NPI Number	:	1649275504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY DIALYSIS ONE, LLC

Provider Business Mailing Address
First Line	:	13311 PIKE RD
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-5111
Country	:	US
Telephone Number	:	281-491-4009
Fax Number	:	866-557-4844

Provider Business Practice Location Address
First Line	:	13311 PIKE RD STE E
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-5111
Country	:	US
Telephone Number	:	281-491-4009
Fax Number	:	866-557-4844

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARIA HEMENEZ
Credential	:	RN
Telephone Number	:	281-491-4009

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	06/16/2018

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Directions to “QUALITY DIALYSIS ONE, LLC ” Practice Location

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