Manchester Dialysis, LLC

Primary specialty

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

Legal business name

MANCHESTER DIALYSIS, LLC

Practice address

3845 E Loop 820 S
Fort Worth, TX 76119-4337

Phone

(817) 496-9035

Fax

(817) 446-0012

NPI assigned

Jul 3, 2014

Organization subpart

No

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

Authorized official

Name

John Winstel

Title

Chief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southeast Fort Worth Dialysis Doing business as

Member of 1

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

• Renal Treatment Centers-Southeast, LP.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Donna, TX
  • NPI 1902353543

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1404345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661990400000",
    "number": "1184030751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-997-4210",
            "fax_number": "866-935-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3845 E LOOP 820 S",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761194337",
            "telephone_number": "817-496-9035",
            "fax_number": "817-446-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCHESTER DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-03",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "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": "364247201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Fort Worth Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeast Fort Worth Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Agnes Jeruto Mamboleo
• Lai Man
• Rodora Hayag Manalansan, RPH
• Manali Healthcare PLLC
• Carina Manalo, DNP, APRN, ACNP, FN
• Kathryn Koheli Mandal, M.D.
• Corey S Mandel, MD
• Mandy Jordan PH.D.
• Adam David Maners
• Shea Maness, MA, BCBA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, 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 Sep 1, 2022; 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.