Healthcare Provider Details

I. General information

NPI: 1083806699
Provider Name (Legal Business Name): SAN ANTONIO KIDNEY DISEASE CENTER PHYSICIANS GROUP, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 E HOUSTON ST STE 103
SAN ANTONIO TX
78202-2951
US

IV. Provider business mailing address

7142 SAN PEDRO AVE STE. 120
SAN ANTONIO TX
78216-6254
US

V. Phone/Fax

Practice location:
  • Phone: 210-228-0743
  • Fax: 210-228-9749
Mailing address:
  • Phone: 210-662-5622
  • Fax: 210-661-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CLAY ROBY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 210-661-5622