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NPI Code Detail

MEDICARE: CENTRAL TEXAS KIDNEY ASSOCIATES

MEDICARE: CENTRAL TEXAS KIDNEY ASSOCIATES
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
1207RN0300XNephrology PhysicianTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11700816923OTHERTX00R28H

General Provider Information

NPI Number : 1700816923
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL TEXAS KIDNEY ASSOCIATES
Provider Business Mailing Address
First Line : 408 W 45TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78751-3014
Country : US
Telephone Number : 512-451-5800
Fax Number : 512-451-5800
Provider Business Practice Location Address
First Line : 408 W 45TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78751-3014
Country : US
Telephone Number : 512-451-5800
Fax Number : 512-451-5800
Authorized Official
Title or Position : ADM
Name : LISA DONNELLY
Credential : ADM
Telephone Number : 512-451-5800
Provider Enumeration Date : 07/04/2006
Last Update Date : 10/29/2012

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Directions to “CENTRAL TEXAS KIDNEY ASSOCIATES ” Practice Location

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