Organization
DIALYSPA MEDICAL CENTER LLC
Active
Parent organization
J GANT LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
J GANT LLC
Authorized official
JEFFREY E KALINA MD (CEO)
(713) 218-6500
Entity
Organization
Contact information
Practice address
2453 S BRAESWOOD BLVD STE 100, HOUSTON, TX 77030-4305
(713) 218-6500
(713) 218-6507
Mailing address
PO BOX 128, BELLAIRE, TX 77402-0128
(281) 833-3330
(281) 833-3323
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
110027
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287805001
—
TX
01
—
672678
MEDICARE PTAN
TX
Enumeration date
11/06/2009
Last updated
08/11/2020
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