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General NPI Number Information
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NPI Number | 1053413187
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Entity Type | Organization
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Legal Business Name | AMARILLO KIDNEY SPECIALISTS, LLC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 8604 S COULTER ST
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City | AMARILLO
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State | TX
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Zip | 79119-7379
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Country | US
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Telephone | 806-358-0051
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Fax | 806-355-0410
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Provider Business Mailing Address
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Address Line | 8604 S COULTER ST
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City | AMARILLO
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State | TX
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Zip | 79119-7379
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Country | US
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Telephone | 806-358-0051
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Fax | 806-355-0410
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | GEORGES MALIHA
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Credential | MD
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Telephone | 806-358-0051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 007962
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License Number State | TX
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