Organization
THE KIDNEY CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHONTAL CARRUTH (BILLING MANAGER)
(806) 778-9842
Entity
Organization
Contact information
Practice address
1126 SLIDE RD, SUITE 4B, LUBBOCK, TX 79416-5402
(806) 771-0906
(806) 771-0896
Mailing address
1126 SLIDE RD, SUITE 4B, LUBBOCK, TX 79416-5402
(806) 771-0906
(806) 771-0896
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
F7299
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
672714
CMS CERTIFICATION NUMBER (CCN)
TX
Enumeration date
03/27/2012
Last updated
05/05/2021
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