Basic Information
| Provider Information | |||||||||
| NPI: | 1326163189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARRIS COUNTY HOSPITAL DISTRICT | ||||||||
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| OtherOrganizationName: | HARRIS HEALTH - RIVERSIDE DIALYSIS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 FOURNACE PL STE 600W | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774012324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3464260478 | ||||||||
| FaxNumber: | 8324872766 | ||||||||
| Practice Location | |||||||||
| Address1: | 3315 DELANO ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770043284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135663929 | ||||||||
| FaxNumber: | 7135215934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | NIKITIN | ||||||||
| AuthorizedOfficialFirstName: | VICTORIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP, CFO | ||||||||
| AuthorizedOfficialTelephone: | 3464260462 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HARRIS COUNTY HOSPITAL DISTRICT | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 008698 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.