1356566194 NPI number — RENAL CARE CONSULTANT, P.A

Table of content: (NPI 1356566194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356566194 NPI number — RENAL CARE CONSULTANT, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL CARE CONSULTANT, P.A
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:
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:
1356566194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11152 WESTHEIMER ROAD
Provider Second Line Business Mailing Address:
# 702
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77042-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-558-8260
Provider Business Mailing Address Fax Number:
281-531-8087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12051 WEST PARK DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77082-5556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-558-8260
Provider Business Practice Location Address Fax Number:
281-531-8087
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERACHA
Authorized Official First Name:
WASEEM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
281-558-8260

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  L0902 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 159588601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5622189 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 390343 . This is a "WELLCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5000634 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10011273 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8H8370 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00028850 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 86872Z . This is a "BCBS HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: MDL0902 . This is a "WORKERS COMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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