Provider Demographics
NPI:1407840291
Name:VAL VERDE RENAL CARE CENTER, INC.
Entity Type:Organization
Organization Name:VAL VERDE RENAL CARE CENTER, INC.
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 1:136 E CONCHO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5947
Mailing Address - Country:US
Mailing Address - Phone:325-653-6773
Mailing Address - Fax:
Practice Address - Street 1:608 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4109
Practice Address - Country:US
Practice Address - Phone:830-774-3031
Practice Address - Fax:830-775-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006901261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH6155OtherBCBS
TX094258301Medicaid
TX094258302Medicaid
TXHH6155OtherBCBS