MEDICARE: KIDNEY SOLUTIONS OF TEXAS 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	008321	TX

General Provider Information

NPI Number	:	1912079658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY SOLUTIONS OF TEXAS LLC

Provider Business Mailing Address
First Line	:	2626 SOUTH LOOP W
Second Line	:	#520
City	:	HOUSTON
State	:	TX
Zip	:	77054-2691
Country	:	US
Telephone Number	:	713-661-7733
Fax Number	:	713-661-7755

Provider Business Practice Location Address
First Line	:	2626 SOUTH LOOP W
Second Line	:	#520
City	:	HOUSTON
State	:	TX
Zip	:	77054-2691
Country	:	US
Telephone Number	:	713-661-7733
Fax Number	:	713-661-7755

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RACHEL EASON
Credential	:	RN
Telephone Number	:	713-661-7733

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	04/25/2008

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