Organization
BRAZOS DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARION WILSON (ADMINISTRATOR)
(281) 240-5095
Entity
Organization
Contact information
Practice address
1730 B.F. TERRY BOULEVARD, ROSENBERG, TX 77471
(832) 595-0003
Mailing address
1730 B.F. TERRY BOULEVARD, ROSENBERG, TX 77471
(832) 595-0003
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
—
672602
MEDICARE PART A
TX
Enumeration date
07/25/2007
Last updated
08/20/2009
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