NPIMap

Organization Active NPI

Elgin Dialysis LLC

Doing business as Fort Stockton Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Stockton, TX
National Provider Identifier
1790046159
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
110157 Issued in TX
Legal business name
ELGIN DIALYSIS LLC
Doing business as
Fort Stockton Dialysis
Practice address
387 Interstate 10 W
Ste C
Fort Stockton, TX 79735-2700
Phone
(432) 336-8041
Fax
(432) 336-8205
NPI assigned
Jun 1, 2012
Last updated
Apr 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Authorized official

Name
James K Hilger
Title
Chief Accounting Officer
Phone
(253) 733-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 110157 TX Primary

Addresses

Primary practice location

387 Interstate 10 W
Ste C
Fort Stockton, TX 79735-2700

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 341-6764

Other identifiers 2

IdentifierTypeStateIssuer
028106OtherTXKIDNEY CARE
311318501MedicaidTX

Other names 1

  • Fort Stockton Dialysis Doing business as

National Provider Directory

National Provider Directory

Member of 2

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

NPI Registry JSON

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

{
    "created_epoch": "1338508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1790046159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-341-6764",
            "fax_number": "833-781-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 INTERSTATE 10 W",
            "address_2": "STE C",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352700",
            "telephone_number": "432-336-8041",
            "fax_number": "432-336-8205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELGIN DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-01",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "HILGER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4500"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "TX",
            "license": "110157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KIDNEY CARE",
            "identifier": "028106",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311318501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Stockton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fort Stockton Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Stockton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.