Phoenix Dialysis LLC

Primary specialty

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

License

110457 Issued in TX

Legal business name

PHOENIX DIALYSIS LLC

Practice address

407 E. South St.
Weimar, TX 78962

Phone

(979) 985-3700

Fax

(979) 859-7154

NPI assigned

Dec 28, 2016

Last updated

Mar 1, 2018By 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

Autumn Dawson

Title

Ceo

Phone

(979) 985-3700

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519862400000",
    "number": "1710422845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 127",
            "city": "FRESNO",
            "state": "TX",
            "postal_code": "775450127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E. SOUTH ST.",
            "city": "WEIMAR",
            "state": "TX",
            "postal_code": "78962",
            "telephone_number": "979-985-3700",
            "fax_number": "979-859-7154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-28",
        "last_updated": "2018-03-01",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "AUTUMN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "979-985-3700"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "TX",
            "license": "110457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Maxwell
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• Leah Rey Mikesky, MD
• Brandie Montgomery
• Estela Mota, M.D
• The Pharmacy Shop of Weimar Inc
• The Pharmacy Shop of Weimar Inc (The Pharmacy Shop)
• Curtis Martin Van Houten, D.O.
• Charles Bancroft Vretis, RPH
• Pattie Stephens Vretis, RPH

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Weimar, TX
• Providers in Weimar, 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 Mar 1, 2018; 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.