MEDICARE: KIDNEY TREATMENT CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	L5868	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205014495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY TREATMENT CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 2169
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77497-2169
Country	:	US
Telephone Number	:	713-774-9090
Fax Number	:	713-774-9091

Provider Business Practice Location Address
First Line	:	6633 HILLCROFT ST
Second Line	:	#118
City	:	HOUSTON
State	:	TX
Zip	:	77081-4887
Country	:	US
Telephone Number	:	713-774-9090
Fax Number	:	713-774-9091

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	RUPERT PATEL
Credential	:	MD
Telephone Number	:	713-774-9090

Provider Enumeration Date	:	02/10/2008
Last Update Date	:	02/10/2008

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