Healthcare Provider Details

I. General information

NPI: 1972038362
Provider Name (Legal Business Name): RENAL CLINIC OF HOUSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 GREENHOUSE RD SUITE 15
HOUSTON TX
77084-7287
US

IV. Provider business mailing address

2222 GREENHOUSE RD SUITE 15
HOUSTON TX
77084-7287
US

V. Phone/Fax

Practice location:
  • Phone: 713-464-9100
  • Fax:
Mailing address:
  • Phone: 713-464-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM4410
License Number StateTX

VIII. Authorized Official

Name: MR. ANDY VERMON
Title or Position: ADMINSTRATOR
Credential:
Phone: 727-214-0462