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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