PONDEROSA DIALYSIS LLC NPI 1275876633

NPI Information

NPI: 1275876633
Provider Name: PONDEROSA DIALYSIS LLC

Doing Business As: VICTORY LAKES DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
3290 GULF FWY S STE H
DICKINSON, TX
ZIP 77539
Phone: (281) 337-2175
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PONDEROSA DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Dickinson, TX. PONDEROSA DIALYSIS LLC NPI is 1275876633. The provider is registered as an organization entity type.
The provider Is Doing Business As Victory Lakes Dialysis.

The provider's business location address is:

3290 GULF FWY S STE H
DICKINSON, TX
ZIP 77539-542
Phone: (281) 337-2175
Fax: (281) 337-2386

The provider's authorized official is John Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The enumeration date for this NPI number is 4/3/2013 and was last updated on 8/5/2021.

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	3469405-01	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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