Organization
LAKE JACKSON DIALYSIS AND KIDNEY CENTER, LTD, LLP
Active
Organization
LAKE JACKSON DIALYSIS AND KIDNEY CENTER, LTD, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL JAEGER (BUSINESS ADMINISTRATOR)
(713) 774-4000
Entity
Organization
Contact information
Practice address
450 THIS WAY ST STE A, LAKE JACKSON, TX 77566-5152
(979) 299-6565
(979) 299-6568
Mailing address
PO BOX 4639, HOUSTON, TX 77210-4639
(979) 864-4330
(979) 864-3560
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
008101
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172906302
—
TX
Enumeration date
07/11/2006
Last updated
08/10/2009
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