Provider Demographics
NPI:1275649402
Name:RENAL SPECIALISTS OF HOUSTON, PA
Entity Type:Organization
Organization Name:RENAL SPECIALISTS OF HOUSTON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-947-9509
Mailing Address - Street 1:11665 FUQUA ST STE C301
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4632
Mailing Address - Country:US
Mailing Address - Phone:713-947-9509
Mailing Address - Fax:
Practice Address - Street 1:11665 FUQUA ST STE C301
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4632
Practice Address - Country:US
Practice Address - Phone:713-947-9509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL SPECIALISTS OF HOUSTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09366841Medicaid
TX09366841Medicaid