MEDICARE: SAN ANTONIO KIDNEY DISEASE CENTER PHYSICIANS GROUP, P.L.L.C.

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	363LF0000X	Family Nurse Practitioner
2	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1265603971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO KIDNEY DISEASE CENTER PHYSICIANS GROUP, P.L.L.C.

Provider Business Mailing Address
First Line	:	7142 SAN PEDRO AVE
Second Line	:	STE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-6256
Country	:	US
Telephone Number	:	210-481-7453
Fax Number	:	210-481-7463

Provider Business Practice Location Address
First Line	:	5000 BAPTIST HEALTH DR
Second Line	:	STE 116
City	:	SCHERTZ
State	:	TX
Zip	:	78154-1193
Country	:	US
Telephone Number	:	210-945-0200
Fax Number	:	210-590-8232

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. CLAY ROBY
Credential	:
Telephone Number	:	210-661-5622

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	04/10/2014

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