Organization
BANNACK DIALYSIS LLC
Active
Other names
Dairy Ashford Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
12606 WESTPARK DR, HOUSTON, TX 77082-5526
(281) 679-1848
(281) 496-2093
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3746448-02
—
TX
Enumeration date
04/21/2016
Last updated
07/17/2024
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