Provider Demographics
NPI:1437625068
Name:PREMIER RENAL PHYSICIANS PLLC
Entity Type:Organization
Organization Name:PREMIER RENAL PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UGOCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-393-9018
Mailing Address - Street 1:10223 BROADWAY ST STE P332
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:281-393-9018
Mailing Address - Fax:281-828-0715
Practice Address - Street 1:4102 WOODLAWN AVE STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1948
Practice Address - Country:US
Practice Address - Phone:281-393-9018
Practice Address - Fax:281-828-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX396343101Medicaid