Provider Demographics
NPI:1528183621
Name:INTERNAL MEDICINE & NEPHROLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE & NEPHROLOGY ASSOCIATES, PA
Other - Org Name:WEST PARK PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:936-328-5820
Mailing Address - Street 1:210 W PARK STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8337
Mailing Address - Country:US
Mailing Address - Phone:936-328-5820
Mailing Address - Fax:936-328-5824
Practice Address - Street 1:210 W PARK STE 104
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8337
Practice Address - Country:US
Practice Address - Phone:936-328-5820
Practice Address - Fax:936-328-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096NCOtherBCBS TX
TXDD5409OtherRAILROAD MEDICARE GROUP #
TXP00234310OtherRAILROAD MEDICARE PIN
TX176014201Medicaid
TXP00234310OtherRAILROAD MEDICARE PIN
TXDD5409OtherRAILROAD MEDICARE GROUP #