1861507964 NPI number — AMARILLO NEPHROLOGY ASSOCIATES, P.A.

Table of content: (NPI 1861507964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861507964 NPI number — AMARILLO NEPHROLOGY ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMARILLO NEPHROLOGY ASSOCIATES, 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:
1861507964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 POINT WEST PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79124-2165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-418-8620
Provider Business Mailing Address Fax Number:
806-418-8626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 POINT WEST PKWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79124-2166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-418-8620
Provider Business Practice Location Address Fax Number:
806-418-8626
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICK
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
806-418-8620

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P3437 . This is a "NEW MEXICO MEDICAID" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: CE1123 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: Z00008AZ4 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00008AZ . This is a "TEXAS BLUE CROSS BLUE SHI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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