Provider Demographics
NPI:1639454630
Name:BASIN KIDNEY CARE SPECIALISTS PA
Entity Type:Organization
Organization Name:BASIN KIDNEY CARE SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NTENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-312-6065
Mailing Address - Street 1:8050 E HWY 191 STE 202
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8613
Mailing Address - Country:US
Mailing Address - Phone:432-312-6065
Mailing Address - Fax:
Practice Address - Street 1:8050 E HWY 191 STE 202
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8613
Practice Address - Country:US
Practice Address - Phone:432-312-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty