Organization Active NPI

Clough Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Frisco, TX
National Provider Identifier
1104378397
Registry record updated Nov 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
CLOUGH DIALYSIS LLC
Practice address
6116 Sports Village Rd
Frisco, TX 75033-3584
Phone
(469) 362-5763
NPI assigned
Nov 4, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2016

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

Authorized official

Name
Mr. Gary J Booth
Title
Ceo
Phone
(305) 651-3261

Specialties & licenses 1

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

Addresses

Primary practice location

6116 Sports Village Rd
Frisco, TX 75033-3584

Mailing address

19559 NE 10TH Ave
North Miami Beach, FL 33179-3501
Phone (305) 651-3261

Other names 1

  • Physicians Dialysis Frisco Doing business as

National Provider Directory

National Provider Directory

Member of 1

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

Locations

19559 NE 10th Ave
North Miami Beach, FL 33179
Phone (305) 651-3261

NPI Registry JSON

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1104378397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19559 NE 10TH AVE",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331793501",
            "telephone_number": "305-651-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6116 SPORTS VILLAGE RD",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750333584",
            "telephone_number": "469-362-5763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOUGH DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2016-11-04",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-651-3261",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Dialysis Frisco",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frisco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2016; 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.