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NPI Code Detail

MEDICARE: KIDNEY CENTER OF WALKER COUNTY LLC

MEDICARE: KIDNEY CENTER OF WALKER COUNTY LLC
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 PhysicianM1828TX

General Provider Information

NPI Number : 1780007435
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDNEY CENTER OF WALKER COUNTY LLC
Provider Business Mailing Address
First Line : 102 MEDICAL PARK LN
Second Line : SUITE A
City : HUNTSVILLE
State : TX
Zip : 77340-4975
Country : US
Telephone Number : 936-294-0971
Fax Number : 936-294-0977
Provider Business Practice Location Address
First Line : 102 MEDICAL PARK LN
Second Line : SUITE A
City : HUNTSVILLE
State : TX
Zip : 77340-4975
Country : US
Telephone Number : 936-294-0971
Fax Number : 936-294-0977
Authorized Official
Title or Position : OWNER
Name : MR. DAVE S KHURANA
Credential : MD
Telephone Number : 936-294-0971
Provider Enumeration Date : 01/31/2014
Last Update Date : 09/22/2014

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Directions to “KIDNEY CENTER OF WALKER COUNTY LLC ” Practice Location

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