NPIMap

Organization Active NPI

County of la Salle

Doing business as La Salle Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cotulla, TX
National Provider Identifier
1508558651
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
COUNTY OF LA SALLE
Doing business as
La Salle Dialysis
Practice address
627 N Baylor St
Cotulla, TX 78014
Phone
(830) 483-5260
Fax
(830) 483-5865
NPI assigned
May 25, 2023
Last updated
May 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Authorized official

Name
Leodoro Martinez III
Title
County Judge
Phone
(830) 483-5139

Specialties & licenses 1

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

Addresses

Primary practice location

627 N Baylor St
Cotulla, TX 78014

Mailing address

300 Santana Row Ste 300
San Jose, CA 95128-2424
Phone (669) 236-5953

Other identifiers 1

IdentifierTypeStateIssuer
110680OtherTXTX HHSC STATE LICENSE

Other names 1

  • La Salle Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230913002455 TX Part A Provider - End-Stage Renal Disease Facility (ESRD) 3173710167 Practice locations: Cotulla, TX

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
SHC LaSalle DialysisCCN 742711
Ownership
Profit
Certified
Mar 19, 2024
Medicare certification status
ActiveFrom the Provider of Services file
Chain
US Renal Care, Inc.
Dialysis stations
13

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
La Salle Co Elderly Nutriition Program4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

627 N Baylor
Cotulla, TX 78014
Phone (830) 483-5260

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avir at CotullaCotulla, TX, CCN 676288 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Mortgage Interest (100%)
Adp of the SNF		 Dec 1, 2022
Dec 1, 2022
Dec 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • County of la Salle

    dba Avir at Cotulla

    • Skilled Nursing Facility
    • Cotulla, TX
    • NPI 1154648459

    5% Or Greater Direct Ownership Interest, 5% Or Greater Mortgage Interest, Adp of the SNF

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1508558651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SANTANA ROW STE 300",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282424",
            "telephone_number": "669-236-5953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 N BAYLOR ST",
            "city": "COTULLA",
            "state": "TX",
            "postal_code": "78014",
            "telephone_number": "830-483-5260",
            "fax_number": "830-483-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LA SALLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-25",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LEODORO",
        "authorized_official_title_or_position": "COUNTY JUDGE",
        "authorized_official_telephone_number": "830-483-5139",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX HHSC STATE LICENSE",
            "identifier": "110680",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Salle Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cotulla, TX

Sources for this page

Verify at the official NPI Registry.