MEDICARE: GREATER HOUSTON KIDNEY CLINIC PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00P9P9	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1477947273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER HOUSTON KIDNEY CLINIC PA

Provider Business Mailing Address
First Line	:	18760 HIGHWAY 59 N STE 100
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4401
Country	:	US
Telephone Number	:	281-312-5558
Fax Number	:	281-727-0827

Provider Business Practice Location Address
First Line	:	18760 HIGHWAY 59 N STE 100
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4401
Country	:	US
Telephone Number	:	281-312-5558
Fax Number	:	281-727-0827

Authorized Official
Title or Position	:	DIRECTOR / OWNER
Name	:	SRIKANTH K RAAYASA
Credential	:	MD
Telephone Number	:	281-747-6025

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	11/20/2025

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