MEDICARE: SOUTH PLAINS RENAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	K8339	TX

General Provider Information

NPI Number	:	1023385382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PLAINS RENAL ASSOCIATES

Provider Business Mailing Address
First Line	:	800 PEAKWOOD DR
Second Line	:	SUITE 6H
City	:	HOUSTON
State	:	TX
Zip	:	77090-2900
Country	:	US
Telephone Number	:	281-580-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W 5TH ST
Second Line	:
City	:	DENVER CITY
State	:	TX
Zip	:	79323-2706
Country	:	US
Telephone Number	:	806-592-2090
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMIR MEMON
Credential	:	MD
Telephone Number	:	281-580-9100

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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