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General NPI Number Information
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NPI Number | 1306520366
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Entity Type | Organization
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Legal Business Name | LONE STAR RENAL PA
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 9800 N BEACH ST STE 500
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City | FORT WORTH
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State | TX
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Zip | 76244-6474
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Country | US
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Telephone | 817-647-9801
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 N BEACH ST STE 500
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City | FORT WORTH
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State | TX
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Zip | 76244-6474
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Country | US
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Telephone | 817-647-9801
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANUSHA JOGIMAHANTI
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Credential | MD
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Telephone | 817-647-9801
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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 |
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