Provider Demographics
NPI:1255385431
Name:SOUTH GESSNER DIALYSIS FACILITY
Entity type:Organization
Organization Name:SOUTH GESSNER DIALYSIS FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELHAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-773-1717
Mailing Address - Street 1:8800 BISSONNET
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2435
Mailing Address - Country:US
Mailing Address - Phone:713-773-1717
Mailing Address - Fax:713-773-1716
Practice Address - Street 1:8800 BISSONNET
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2435
Practice Address - Country:US
Practice Address - Phone:713-773-1717
Practice Address - Fax:713-773-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008322261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX672551Medicare Oscar/Certification