MEDICARE: WEST TEXAS RENAL CARE CENTER INC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	006902	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
2	HH6151	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1609860485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST TEXAS RENAL CARE CENTER INC

Provider Business Mailing Address
First Line	:	136 E CONCHO AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76903-5947
Country	:	US
Telephone Number	:	325-653-6773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 EXECUTIVE DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6883
Country	:	US
Telephone Number	:	325-949-5081
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. STEVE F MONTOYA JR.
Credential	:	M.D.
Telephone Number	:	325-653-6773

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	02/03/2012

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Directions to “WEST TEXAS RENAL CARE CENTER INC ” Practice Location

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