Provider Demographics
NPI:1477947273
Name:GREATER HOUSTON KIDNEY CLINIC PA
Entity Type:Organization
Organization Name:GREATER HOUSTON KIDNEY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAAYASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-747-6025
Mailing Address - Street 1:23814 HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1510
Mailing Address - Country:US
Mailing Address - Phone:281-312-5558
Mailing Address - Fax:281-727-0827
Practice Address - Street 1:23814 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1510
Practice Address - Country:US
Practice Address - Phone:281-312-5558
Practice Address - Fax:281-727-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P9P9OtherBCBS OF TEXAS
TX00P9P9OtherBCBS OF TEXAS