MEDICARE: METHODIST NEPHROLOGY PLLC

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

General Provider Information

NPI Number	:	1235502733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST NEPHROLOGY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 56072
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77256-6072
Country	:	US
Telephone Number	:	281-252-9993
Fax Number	:

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST
Second Line	:	SUITE 1726
City	:	HOUSTON
State	:	TX
Zip	:	77030-2761
Country	:	US
Telephone Number	:	281-252-9993
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHOUIEB TAMBRA
Credential	:	M.D.
Telephone Number	:	281-252-9993

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	01/04/2016

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