Healthcare Provider Details

I. General information

NPI: 1417594995
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: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7114 SAN PEDRO AVE
SAN ANTONIO TX
78216-6218
US

IV. Provider business mailing address

7142 SAN PEDRO AVE STE 120
SAN ANTONIO TX
78216-6256
US

V. Phone/Fax

Practice location:
  • Phone: 210-342-2233
  • Fax:
Mailing address:
  • Phone: 210-661-5622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLAIBORNE B. ROBY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 210-661-5622