| Organization Name: | LAKE JACKSON DIALYSIS AND KIDNEY CENTER, LTD, LLP |
| NPI Number: | 1215961545 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL JAEGER (BUSINESS ADMINISTRATOR) |
| Mailing Address: | 450 This Way St Ste A Lake Jackson |
| State: | TX US |
| Postal Code: | 775665152 |
| Phone Number: | 9792996565 |
| Fax Number: | 9792996568 |
| NPI Enumeration Date: | 07/11/2006 |
| NPI Last Update Date: | 08/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | 008101 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |