| Organization Name: | WAXLD LLC |
| NPI Number: | 1033423173 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN B PARDO (VICE PRESIDENT) |
| Mailing Address: | 1011 N Highway 77 Ste 102 Waxahachie |
| State: | TX US |
| Postal Code: | 751651798 |
| Phone Number: | 9723518575 |
| Fax Number: | |
| NPI Enumeration Date: | 07/30/2010 |
| NPI Last Update Date: | 01/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |