1083718175 NPI number — SAN ANTONIO NEPHROLOGY ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083718175 NPI number — SAN ANTONIO NEPHROLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO NEPHROLOGY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083718175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
343 W HOUSTON ST
Provider Second Line Business Mailing Address:
SUITE 906
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-277-1011
Provider Business Mailing Address Fax Number:
210-277-1090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
343 W HOUSTON ST
Provider Second Line Business Practice Location Address:
SUITE 906
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-277-1011
Provider Business Practice Location Address Fax Number:
210-277-1090
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NANCHERLA
Authorized Official First Name:
PRAKASH
Authorized Official Middle Name:
RAO
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
210-277-1011

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 890157 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: G7697 . This is a "TX LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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