HEADLANDS DIALYSIS LLC NPI 1659771624

NPI Information

NPI: 1659771624
Provider Name: HEADLANDS DIALYSIS, LLC

Doing Business As: HULEN DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 45D2086242

Address:
5832 S HULEN ST
FORT WORTH, TX
ZIP 76132
Phone: (817) 370-7642
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HEADLANDS DIALYSIS, LLC is an end-stage renal disease (esrd) treatment clinic center in Fort Worth, TX. HEADLANDS DIALYSIS, LLC NPI is 1659771624. The provider is registered as an organization entity type.
The provider Is Doing Business As Hulen Dialysis.

The provider's business location address is:

5832 S HULEN ST
FORT WORTH, TX
ZIP 76132-684
Phone: (817) 370-7642
Fax: (817) 370-7774

The provider's authorized official is Samuel T Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 45D2086242 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/27/2014 and was last updated on 12/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	110287	OTHER	TEXAS	STATE LICENSE
2	366417901	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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