MEDICARE: SOUTH PLAINS RENAL ASSOCIATES

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	K8339	TX

General Provider Information

NPI Number	:	1720275399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PLAINS RENAL ASSOCIATES

Provider Business Mailing Address
First Line	:	12834 WILLOW CENTRE DR STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3047
Country	:	US
Telephone Number	:	281-580-9100
Fax Number	:	281-580-9577

Provider Business Practice Location Address
First Line	:	12834 WILLOW CENTRE DR STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3047
Country	:	US
Telephone Number	:	281-580-9100
Fax Number	:	281-580-9577

Authorized Official
Title or Position	:	DIRECTOR
Name	:	AMIR MEMON
Credential	:	MD
Telephone Number	:	281-580-9100

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	01/22/2020

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Directions to “SOUTH PLAINS RENAL ASSOCIATES ” Practice Location

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