Provider Demographics
NPI:1376548008
Name:WEST TEXAS NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:WEST TEXAS NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:325-653-6773
Mailing Address - Street 1:PO BOX 5780
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-5780
Mailing Address - Country:US
Mailing Address - Phone:325-653-6773
Mailing Address - Fax:325-653-3849
Practice Address - Street 1:136 E CONCHO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5947
Practice Address - Country:US
Practice Address - Phone:325-653-6773
Practice Address - Fax:325-653-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00KL07207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112858904Medicaid
TXCP4155OtherRAILROAD MEDICARE
TX00KL07Medicare PIN