NPIMap

Organization Active NPI

Matagorda Dialysis Care LLP

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bay City, TX
National Provider Identifier
1104255645
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
MATAGORDA DIALYSIS CARE LLP
Practice address
1105 Avenue H
Bay City, TX 77414-3538
Phone
(979) 245-0099
Fax
(979) 245-6435
NPI assigned
Nov 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Authorized official

Name
Sara Anne Brady
Title
Chief Nursing Officer
Phone
(208) 371-7878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1105 Avenue H
Bay City, TX 77414-3538

Mailing address

1105 Avenue H
Bay City, TX 77414-3538
Phone (979) 245-0099

Other identifiers 1

IdentifierTypeStateIssuer
335873101MedicaidTX

National Provider Directory

National Provider Directory

Locations

1105 Avenue H
Bay City, TX 77414
Phone (979) 245-0099

NPI Registry JSON

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1104255645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 AVENUE H",
            "city": "BAY CITY",
            "state": "TX",
            "postal_code": "774143538",
            "telephone_number": "979-245-0099",
            "fax_number": "979-245-6435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 AVENUE H",
            "city": "BAY CITY",
            "state": "TX",
            "postal_code": "774143538",
            "telephone_number": "979-245-0099",
            "fax_number": "979-245-6435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATAGORDA DIALYSIS CARE LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-05",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "208-371-7878"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "335873101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay City, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; 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.