SNG - Abita Square Dialysis Center LP

Primary specialty

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

Legal business name

SNG - ABITA SQUARE DIALYSIS CENTER LP

Practice address

21501 Highway 36
Abita Springs, LA 70420-3907

Phone

(985) 898-4898

Fax

(985) 898-3848

NPI assigned

Oct 25, 2012

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kinam C. Martin

Title

Chief Operations Officer

Phone

(817) 725-7900

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1588917702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043029",
            "telephone_number": "817-725-7900",
            "fax_number": "682-207-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21501 HIGHWAY 36",
            "city": "ABITA SPRINGS",
            "state": "LA",
            "postal_code": "704203907",
            "telephone_number": "985-898-4898",
            "fax_number": "985-898-3848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SNG - ABITA SQUARE DIALYSIS CENTER LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KINAM",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "817-725-7900"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY LICENSE",
            "identifier": "2203781411",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2347527",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina M Richardson, CMA
• Charlie Rick
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• William Bryan Sadler, PLPC
• Patricia Stout, LCSW
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• The Well Life Integrative Health Inc (The Well Life Integrative Health)
• Eric Valverde, PLPC
• Walgreen Co (Walgreens #11996)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Abita Springs, LA
• Providers in Abita Springs, LA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.