MEDICARE: NORTH SHEPHERD KIDNEY CLINIC, 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

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	:	1992823025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHEPHERD KIDNEY CLINIC, INC.

Provider Business Mailing Address
First Line	:	7272 N SHEPHERD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-2435
Country	:	US
Telephone Number	:	713-697-1115
Fax Number	:	713-697-1116

Provider Business Practice Location Address
First Line	:	7272 N SHEPHERD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-2435
Country	:	US
Telephone Number	:	713-697-1115
Fax Number	:	713-697-1116

Authorized Official
Title or Position	:	TREASURER
Name	:	WADI N SUKI
Credential	:
Telephone Number	:	713-790-9080

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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