MEDICARE: WICHITA FALLS NEPHROLOGY ASSOCIATES, 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	K1614	TX

General Provider Information

NPI Number	:	1538411905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICHITA FALLS NEPHROLOGY ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	1517 10TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4404
Country	:	US
Telephone Number	:	940-322-1411
Fax Number	:	940-322-2120

Provider Business Practice Location Address
First Line	:	1517 10TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4404
Country	:	US
Telephone Number	:	940-322-1411
Fax Number	:	940-322-2120

Authorized Official
Title or Position	:	OWNER
Name	:	ASHVIN PATEL
Credential	:	M.D.
Telephone Number	:	940-322-1411

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	11/02/2012

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