Provider Demographics
NPI:1871055822
Name:EASTLAND DIALYSIS CENTER, LLC
Entity type:Organization
Organization Name:EASTLAND DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-631-5342
Mailing Address - Street 1:304 S. DAUGHERTY STREET
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448
Mailing Address - Country:US
Mailing Address - Phone:254-631-5342
Mailing Address - Fax:
Practice Address - Street 1:2300 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448
Practice Address - Country:US
Practice Address - Phone:254-629-3600
Practice Address - Fax:254-629-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Multi-Specialty
No2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Multi-Specialty