MEDICARE: BRAZOS HYPERTENSION AND KIDNEY CARE 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	:	1487133120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAZOS HYPERTENSION AND KIDNEY CARE PLLC

Provider Business Mailing Address
First Line	:	2310 DE LEE ST STE 100
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-485-9496
Fax Number	:	979-485-9497

Provider Business Practice Location Address
First Line	:	2310 DE LEE ST STE 100
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-485-9496
Fax Number	:	979-485-9497

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHIZOBA C OBI
Credential	:	MD
Telephone Number	:	314-915-6761

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	07/23/2023

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