MEDICARE: THE DIALYSIS COTTAGE 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	008551	TX

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	008551	OTHER	TX	DSHS

General Provider Information

NPI Number	:	1922000587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DIALYSIS COTTAGE LLC

Provider Business Mailing Address
First Line	:	1902 HOSPITAL BLVD
Second Line	:	SUITE D
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-2007
Country	:	US
Telephone Number	:	940-612-1642
Fax Number	:	940-612-2360

Provider Business Practice Location Address
First Line	:	1902 HOSPITAL BLVD
Second Line	:	SUITE D
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-2007
Country	:	US
Telephone Number	:	940-612-1642
Fax Number	:	940-612-2360

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. TRISH A WHITE
Credential	:	RN, CNN
Telephone Number	:	940-612-1642

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/27/2010

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Directions to “THE DIALYSIS COTTAGE LLC ” Practice Location

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