MEDICARE: BEECHNUT DIALYSIS CENTER 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	2472R0900X	Renal Dialysis Technician	0080004	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

General Provider Information

NPI Number	:	1972509859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEECHNUT DIALYSIS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 720540
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77272-0540
Country	:	US
Telephone Number	:	713-772-5228
Fax Number	:	713-490-2344

Provider Business Practice Location Address
First Line	:	8325 BEECHNUT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-6853
Country	:	US
Telephone Number	:	713-772-5228
Fax Number	:	713-490-2344

Authorized Official
Title or Position	:	CEO
Name	:	MRS. RITA PATEL
Credential	:
Telephone Number	:	832-265-2341

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	04/21/2021

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