Rayburn Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

110111 Issued in TX

Legal business name

RAYBURN DIALYSIS LLC

Doing business as

Odessa Dialysis

Practice address

6005 Eastridge Rd
Odessa, TX 79762-5019

Phone

(432) 362-3008

Fax

(432) 362-3302

NPI assigned

Dec 6, 2011

Last updated

Dec 21, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James K Hilger

Title

Chief Accounting Officer

Phone

(253) 382-1919

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Odessa Dialysis Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Bainbridge Dialysis LLC

  dba Central Fort Worth Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Worth, TX
  • NPI 1699041152

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356048000000",
    "number": "1053689034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4550",
            "fax_number": "866-500-8578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6005 EASTRIDGE RD",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625019",
            "telephone_number": "432-362-3008",
            "fax_number": "432-362-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAYBURN DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-06",
        "last_updated": "2012-12-21",
        "status": "A",
        "authorized_official_last_name": "HILGER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-382-1919"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "TX",
            "license": "110111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KIDNEY PROGRAM",
            "identifier": "027740",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297639101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odessa Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vivek U Rao, MD
• Raphael E Nwojo MD PA (West Texas Ear, Nose, Throat and Sinus Institute)
• Mark Raymond Rapisura, MD
• Virginia Lynn Rauth, MD
• Ravi Medi
• Josue Raygosa, PHARM D.
• Razzak Jabur M D P a
• Recover Home Therapy Inc
• Sanjay Reddi, B.D.S., M.D.
• Anand C Reddy, MD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Odessa, TX
• Providers in Odessa, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.