Organization
PREMIER STATEWIDE DIALYSIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CLARK (A R SUPERVISOR)
(936) 891-5572
Entity
Organization
Contact information
Practice address
1406 S CLARK RD, DUNCANVILLE, TX 75137
(972) 709-1950
(972) 709-1949
Mailing address
1406 S CLARK RD, DUNCANVILLE, TX 75137
(972) 709-1950
(972) 709-1949
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
008102
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH6483
BC BS
TX
Enumeration date
06/01/2006
Last updated
08/22/2020
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