Provider Demographics
NPI:1023385382
Name:SOUTH PLAINS RENAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH PLAINS RENAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-580-9100
Mailing Address - Street 1:800 PEAKWOOD DR
Mailing Address - Street 2:SUITE 6H
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2900
Mailing Address - Country:US
Mailing Address - Phone:281-580-9100
Mailing Address - Fax:
Practice Address - Street 1:500 W 5TH ST
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-2706
Practice Address - Country:US
Practice Address - Phone:806-592-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8339207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty