Organization
SNG - ABITA SQUARE DIALYSIS CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KINAM C. MARTIN (CHIEF OPERATIONS OFFICER)
(817) 725-7900
Entity
Organization
Contact information
Practice address
21501 HIGHWAY 36, ABITA SPRINGS, LA 70420-3907
(985) 898-4898
(985) 898-3848
Mailing address
1000 W CANNON ST, FORT WORTH, TX 76104-3029
(817) 725-7900
(682) 207-1030
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
01
—
2203781411
FACILITY LICENSE
LA
05
—
2347527
—
LA
Enumeration date
10/25/2012
Last updated
07/21/2022
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