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General NPI Number Information
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NPI Number | 1164645511
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Entity Type | Organization
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Legal Business Name | SPACE CITY ASSOCIATES OF NEPHROLOGY, PA
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 560 BLOSSOM ST STE C
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City | WEBSTER
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State | TX
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Zip | 77598-4237
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Country | US
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Telephone | 832-905-6141
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Fax | 832-200-3259
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Provider Business Mailing Address
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Address Line | 2301 CARINA CT
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City | LEAGUE CITY
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State | TX
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Zip | 77573-2879
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Country | US
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Telephone | 281-554-5445
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Fax | 281-554-5445
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MAHENDRA AGRAHARKAR
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Credential | M.D.
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Telephone | 832-905-6141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State | TX
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