Organization
EUMANA HOME DIALYSIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CLARK (AR SUPERVISOR)
(936) 597-6467
Entity
Organization
Contact information
Practice address
1313 LA CONCHA LN, HOUSTON, TX 77054-1809
(713) 668-2744
(713) 795-5959
Mailing address
1313 LA CONCHA LN, HOUSTON, TX 77054-1809
(713) 668-2744
(713) 795-5959
Taxonomy
Speciality
Code
Description
License number
State
163WN0300X
Nephrology Registered Nurse
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1242590001
DMERC
TX
05
—
154141902
—
TX
01
—
531721
BCBS
TX
01
—
HH6415
BCBS
TX
Enumeration date
05/31/2006
Last updated
07/22/2008
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