Provider Demographics
NPI:1487650974
Name:RENAL PHYSICIANS OF MONTGOMERY COUNTY, P.A.
Entity Type:Organization
Organization Name:RENAL PHYSICIANS OF MONTGOMERY COUNTY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-756-2555
Mailing Address - Street 1:200 RIVER POINTE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2817
Mailing Address - Country:US
Mailing Address - Phone:936-756-2555
Mailing Address - Fax:936-756-2534
Practice Address - Street 1:200 RIVER POINTE DR STE 120
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2817
Practice Address - Country:US
Practice Address - Phone:936-756-2555
Practice Address - Fax:936-756-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109487202Medicaid