Organization
WICHITA FALLS KIDNEY DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYASANKAR REDDY M.D (DIRECTOR)
(940) 716-0557
Entity
Organization
Contact information
Practice address
1104 HOLLIDAY ST, WICHITA FALLS, TX 76301-4422
(940) 716-0557
Mailing address
1508 10TH ST, STE B, WICHITA FALLS, TX 76301-4401
(940) 716-0557
(940) 355-0028
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
—
3964322-01
—
TX
01
—
HH486Y
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/07/2016
Last updated
01/26/2020
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