Provider Demographics
NPI:1083856512
Name:KIDNEY DISEASE SPECIALISTS OF WEST TEXAS PA
Entity Type:Organization
Organization Name:KIDNEY DISEASE SPECIALISTS OF WEST TEXAS PA
Other - Org Name:LARRY A WARMOTH MD PRESIDENT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:806-798-1594
Mailing Address - Street 1:5109 82ND ST
Mailing Address - Street 2:STE 7 #1114
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3028
Mailing Address - Country:US
Mailing Address - Phone:806-798-1594
Mailing Address - Fax:806-794-0125
Practice Address - Street 1:3801 21ST ST STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1006
Practice Address - Country:US
Practice Address - Phone:806-687-0338
Practice Address - Fax:806-687-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4599207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID