MEDICARE: HUNT COUNTY REGIONAL DIALYSIS 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

General Provider Information

NPI Number	:	1710460548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNT COUNTY REGIONAL DIALYSIS CENTER LLC

Provider Business Mailing Address
First Line	:	3301 RIDGECREST RD STE 1
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6251
Country	:	US
Telephone Number	:	903-455-0579
Fax Number	:	903-455-0586

Provider Business Practice Location Address
First Line	:	3301 RIDGECREST RD STE 1
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6251
Country	:	US
Telephone Number	:	903-455-0579
Fax Number	:	903-455-0586

Authorized Official
Title or Position	:	CHIEF NURSING OFFICER
Name	:	SARA ANNE BRADY
Credential	:
Telephone Number	:	208-371-7878

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	06/08/2026

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