MANCHESTER DIALYSIS, LLC (NPI# 1184030751) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184030751 |
| Entity Type | Organization |
| Organization Name | MANCHESTER DIALYSIS, LLC |
| Other Organization Name | SOUTHEAST FORT WORTH DIALYSIS |
| Practice Address |
3845 E Loop 820 S Fort Worth TX 76119-4337 |
| Mailing Address |
5200 Virginia Way L&c Department Brentwood TN 37027-7569 |
| Practice Telephone | 8174969035 |
| Practice Fax Number | 8174460012 |
| Mailing Telephone | 6153416764 |
| Mailing Fax Number | 8337816999 |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2019-05-23 |
| Authorized Official Name | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2537334500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 364247201 | 05 |
| Other Name | Type Code |
|---|---|
| Southeast Fort Worth Dialysis | Doing Business As Name - Organization |
| Street Address |
3845 E LOOP 820 S |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76119-4337 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467003111 | Asha Jamilia Robertson | Technician | 5321 Rita Kay Ln Lot #21, Fort Worth, TX 76119 | 2019-09-24 |
| 1801366406 | Gina Stovall | Behavioral Analyst | 1100 Circle Drive Suite 101, Fort Worth, TX 76119 | 2018-11-27 |
| 1730660374 | Lisa Alfaro Williams | Counselor | 3120, 22, 24 S.e. Loop 820, Fort Worth, TX 76119 | 2018-08-22 |
| 1023597366 | Gregoire M Butera | Registered Nurse | 3883 Mighty Mite Dr., Fort Worth, TX 76119 | 2018-08-08 |
| 1598244816 | Tawnya R Anderson | Registered Nurse | 3883 Mighty Mite Drive, Fort Worth, TX 76119 | 2018-08-08 |
| 1730699802 | Miller Dental Pllc | Dentist | 3307 Miller Ave Suite #a, Fort Worth, TX 76119 | 2017-10-03 |
| 1053853697 | Carla Walter | Community Health Worker | 4125 Hardeman Ave, Fort Worth, TX 76119 | 2016-11-14 |
| 1710238134 | Thuy Vy Phan | Physician Assistant | 2500 Circle Dr, Fort Worth, TX 76119 | 2012-09-25 |
| 1598031841 | Candace Frances Been | Podiatrist | Federal Bureau of Prisons Federal Medical Center Fort, 3150 Horton Road, Fort Worth, TX 76119 | 2012-03-30 |
| 1053600262 | Miller Dental | Dentist | 3307 Miller Ave Suite A, Fort Worth, TX 76119 | 2011-03-29 |
| Find all providers in zip 76119 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437756772 | Usrc Bluebonnet, LLC | Clinic/Center | 1902 Windsor Pl, Ste 100, Fort Worth, TX 76110-1866 | 2020-10-08 |
| 1609473941 | Usrc Bluebonnet Home, LLC | Clinic/Center | 1902 Windsor Pl Ste 202, Fort Worth, TX 76110-1866 | 2020-10-08 |
| 1194296202 | Fresenius Medical Care Keller, LLC | Clinic/Center | 3700 N Tarrant Pkwy, Fort Worth, TX 76177 | 2018-12-16 |
| 1992213078 | Fresenius Medical Care Se Fort Worth, LLC | Clinic/Center | 3708 E Rosedale St, Fort Worth, TX 76105 | 2018-01-11 |
| 1184024770 | Kerricher Dialysis, LLC | Clinic/Center | 2400 Lands End Blvd, Ste 131, Fort Worth, TX 76116-2170 | 2014-09-02 |
| 1659771624 | Headlands Dialysis, LLC | Clinic/Center | 5832 S Hulen St, Fort Worth, TX 76132-2684 | 2014-08-27 |
| 1235538299 | Hugo Dialysis, LLC | Clinic/Center | 11000 Old Denton Rd, Fort Worth, TX 76244-5407 | 2014-08-15 |
| 1528480837 | Usrc Bryant Irvin, LLC | Clinic/Center | 5729 Bryant Irvin Rd, Fort Worth, TX 76132 | 2014-01-07 |
| 1730517541 | North Arlington Dialysis Center LLC | Clinic/Center | 1451 Eastchase Pkwy, Fort Worth, TX 76120-4403 | 2013-10-15 |
| 1770915217 | Renal Center of Keller, LLC | Clinic/Center | 10708 Victoria Ash Dr, Fort Worth, TX 76244-6392 | 2013-08-07 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76119 |
Please comment or provide details below to improve the information on MANCHESTER DIALYSIS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.