NPIMap

Organization Active NPI

Upper Valley Dialysis Access Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Mission, TX
National Provider Identifier
1932856945
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
UPPER VALLEY DIALYSIS ACCESS CENTER, LLC
Practice address
1203 St Claire Blvd Unit 13B
Mission, TX 78572-8465
Phone
(956) 600-8899
Fax
(956) 600-7511
NPI assigned
Mar 9, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Authorized official

Name
Benjamin LeeNPI 1871784967
Title
Owner
Phone
(956) 600-8899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1203 St Claire Blvd Unit 13B
Mission, TX 78572-8465

Mailing address

5913 Lago Vista Dr
Corpus Christi, TX 78414-6335

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220418001172 TX Part B Supplier - Ambulatory Surgical Center 9739576943 Receives reassigned benefits from 3 practitioners
Practice locations: Mission, TX

Ambulatory surgical center certification: CCN 45C0451250

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Upper Valley Dialysis Access Center LLC,
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Nov 11, 2022
Last certification
Oct 20, 2022
Ownership / control type
Proprietary
Facility address
1203 ST Claire Blvd Unit 13B
Mission, TX 78572

National Provider Directory

National Provider Directory

Locations

1203 St Claire Blvd
Ste 13B
Mission, TX 78572
Phone (330) 394-1152

1203 St Claire Blvd
Unit 1314
Mission, TX 78572

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1932856945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5913 LAGO VISTA DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784146335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 ST CLAIRE BLVD UNIT 13B",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785728465",
            "telephone_number": "956-600-8899",
            "fax_number": "956-600-7511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER VALLEY DIALYSIS ACCESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "956-600-8899"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission, TX

Sources for this page

Verify at the official NPI Registry.