MEDICARE: SNG - BARLITE SAN SABA DIALYSIS CENTERS 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	110053	OTHER	TX	FACILITY LICENSE

General Provider Information

NPI Number	:	1760700298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNG - BARLITE SAN SABA DIALYSIS CENTERS 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	:	7500 BARLITE
Second Line	:	STE 103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78224-1362
Country	:	US
Telephone Number	:	210-922-3377
Fax Number	:	210-922-2311

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

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	11/08/2019

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