MEDICARE: BLALOCK DIALYSIS CENTER INC

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	110188	TX

General Provider Information

NPI Number	:	1801156369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLALOCK DIALYSIS CENTER INC

Provider Business Mailing Address
First Line	:	1170 BLALOCK RD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7421
Country	:	US
Telephone Number	:	713-463-6611
Fax Number	:	281-817-7725

Provider Business Practice Location Address
First Line	:	1170 BLALOCK RD
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77055-7421
Country	:	US
Telephone Number	:	713-464-0236
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PINAKIN R PATEL
Credential	:	M.D.
Telephone Number	:	713-464-0236

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	08/15/2022

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