MEDICARE: WEST TEXAS NEPHROLOGY 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	00KL07	TX

General Provider Information

NPI Number	:	1922280882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST TEXAS NEPHROLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 5780
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76902-5780
Country	:	US
Telephone Number	:	325-949-5081
Fax Number	:	325-653-5733

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	:	MD
Telephone Number	:	325-949-5081

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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