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NPI Code Detail

MEDICARE: EUMANA HOME DIALYSIS INC

MEDICARE: EUMANA HOME DIALYSIS 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
1163WN0300XNephrology Registered Nurse

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11242590001OTHERTXDMERC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3HH6415OTHERTXBCBS
4531721OTHERTXBCBS

General Provider Information

NPI Number : 1841237021
Entity Type Code : Organization
Provider Name (Legal Business Name) : EUMANA HOME DIALYSIS INC
Provider Business Mailing Address
First Line : 1313 LA CONCHA LN
Second Line :
City : HOUSTON
State : TX
Zip : 77054-1809
Country : US
Telephone Number : 713-668-2744
Fax Number : 713-795-5959
Provider Business Practice Location Address
First Line : 1313 LA CONCHA LN
Second Line :
City : HOUSTON
State : TX
Zip : 77054-1809
Country : US
Telephone Number : 713-668-2744
Fax Number : 713-795-5959
Authorized Official
Title or Position : AR SUPERVISOR
Name : DAVID CLARK
Credential :
Telephone Number : 936-597-6467
Provider Enumeration Date : 05/31/2006
Last Update Date : 07/22/2008

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Directions to “EUMANA HOME DIALYSIS INC ” Practice Location

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