Lake Jackson Dialysis and Kidney Center, LTD, LLP

Primary specialty

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

License

008264 Issued in TX

Legal business name

LAKE JACKSON DIALYSIS AND KIDNEY CENTER, LTD, LLP

Practice address

102 E Hospital Dr
Angleton, TX 77515-4112

Phone

(979) 864-4330

Fax

(979) 864-3560

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Judith Gold, MD

Title

Medical Director

Phone

(979) 864-4330

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Angleton Kidney Center Doing business as

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249862400000",
    "number": "1487793386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4639",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772104639",
            "telephone_number": "979-864-4330",
            "fax_number": "979-864-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E HOSPITAL DR",
            "city": "ANGLETON",
            "state": "TX",
            "postal_code": "775154112",
            "telephone_number": "979-864-4330",
            "fax_number": "979-864-3560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE JACKSON DIALYSIS AND KIDNEY CENTER, LTD, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2009-08-10",
        "status": "A",
        "authorized_official_last_name": "GOLD",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "979-864-4330",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "TX",
            "license": "008264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182096102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angleton Kidney Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Ann Korenek, WHCNP
• Aaron Joseph Krodel, MS, LPC
• Kroger Texas L P
• Blair Kveton
• KWP Healthcare, LLC
• Adnan Lakhani, M.D.
• Swarna Lam
• Ginger Kay Langdon, PT
• Nicholas Anthony Larocca
• Karen L Lazard, PA-C

• All providers in Angleton, TX
• 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 Aug 10, 2009; 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.