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NPI Code Detail

MEDICARE: CENTRAL TEXAS NEPHROLOGY ASSOCIATES, P.A.

MEDICARE: CENTRAL TEXAS NEPHROLOGY ASSOCIATES, P.A.
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
1207RN0300XNephrology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174578918
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL TEXAS NEPHROLOGY ASSOCIATES, P.A.
Provider Business Mailing Address
First Line : 5940 CROSSLAKE PKWY
Second Line :
City : WACO
State : TX
Zip : 76712-6986
Country : US
Telephone Number : 254-666-2999
Fax Number : 254-666-6000
Provider Business Practice Location Address
First Line : 5940 CROSSLAKE PKWY
Second Line :
City : WACO
State : TX
Zip : 76712-6986
Country : US
Telephone Number : 254-666-2999
Fax Number : 254-666-6000
Authorized Official
Title or Position : ADMINISTRATOR
Name : DANNY PRYOR
Credential :
Telephone Number : 254-666-2999
Provider Enumeration Date : 05/23/2006
Last Update Date : 03/09/2015

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