Organization
GLACIER DIALYSIS LLC
Active
Other names
North Park Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
324 FM 1960 RD STE 104, HOUSTON, TX 77073-1887
(281) 443-2209
(281) 443-1983
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6764
(833) 781-6999
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
—
322417201
—
TX
Enumeration date
10/05/2012
Last updated
08/26/2021
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