Provider Demographics
NPI:1588826754
Name:CENTRAL TEXAS KIDNEY ASSOC PA
Entity Type:Organization
Organization Name:CENTRAL TEXAS KIDNEY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:512-451-5800
Mailing Address - Street 1:408 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3014
Mailing Address - Country:US
Mailing Address - Phone:512-451-5800
Mailing Address - Fax:512-459-1399
Practice Address - Street 1:408 W 45TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3014
Practice Address - Country:US
Practice Address - Phone:512-451-5800
Practice Address - Fax:512-459-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06727314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility