Provider Demographics
NPI:1679128417
Name:LONESTAR NEPHROLOGY CARE PLLC
Entity Type:Organization
Organization Name:LONESTAR NEPHROLOGY CARE PLLC
Other - Org Name:TEXAS RENAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:SAEED
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-547-6969
Mailing Address - Street 1:4833 MEDICAL CENTER DR BLDG 6B
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1898
Mailing Address - Country:US
Mailing Address - Phone:972-847-6969
Mailing Address - Fax:972-542-5482
Practice Address - Street 1:4833 MEDICAL CENTER DR BLDG 6B
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1898
Practice Address - Country:US
Practice Address - Phone:972-847-6969
Practice Address - Fax:972-542-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX411337501Medicaid