Provider Demographics
NPI:1235502733
Name:METHODIST NEPHROLOGY PLLC
Entity Type:Organization
Organization Name:METHODIST NEPHROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOUIEB
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-252-9993
Mailing Address - Street 1:PO BOX 56072
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77256-6072
Mailing Address - Country:US
Mailing Address - Phone:281-252-9993
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1726
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:281-252-9993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty