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4300 Fairmont Pkwy Ste 100 Pasadena TX 77504 | |
| (832) 617-8816 | |
| (713) 513-5394 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - End-stage Renal Disease (esrd) Treatment |
| Location | 4300 Fairmont Pkwy Ste 100, Pasadena, Texas |
| Authorized Official Name and Position | Alan Comple (FACILITY ADMINISTRATOR) |
| Authorized Official Contact | 7135693961 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4300 Fairmont Pkwy Ste 100 Pasadena TX 77504-3306 Ph: (832) 617-8816 | 4300 Fairmont Pkwy Ste 100 Pasadena TX 77504 Ph: (832) 617-8816 |
| NPI Number | 1184117103 |
|---|---|
| Provider Enumeration Date | 06/13/2018 |
| Last Update Date | 06/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184117103 | NPI | - | NPPES |
| 110508 | Other | TX | ESRD LICENSE |
| 1976747 | Other | TX | NOVITAS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| 261QE0700X | Clinic/center - End-stage Renal Disease (esrd) Treatment | (* (Not Available)) | Primary |
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