MEDICARE: ROMANO WOODS KIDNEY CLINIC, INC.

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1508040668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROMANO WOODS KIDNEY CLINIC, INC.

Provider Business Mailing Address
First Line	:	1415 LA CONCHA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1801
Country	:	US
Telephone Number	:	713-790-9080
Fax Number	:	713-335-4281

Provider Business Practice Location Address
First Line	:	16910 MATHIS CHURCH ROAD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3705
Country	:	US
Telephone Number	:	281-433-4792
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CARLOS F. GONZALEZ
Credential	:
Telephone Number	:	713-790-9080

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	02/12/2008

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