Provider Demographics
NPI:1689209157
Name:KIDNEY AND PRIMARY CARE OF TEXAS LLC
Entity Type:Organization
Organization Name:KIDNEY AND PRIMARY CARE OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRINATH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMIRISA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-947-6491
Mailing Address - Street 1:3939 MEDICAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2292
Mailing Address - Country:US
Mailing Address - Phone:210-858-7604
Mailing Address - Fax:210-888-0383
Practice Address - Street 1:3939 MEDICAL DR STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2292
Practice Address - Country:US
Practice Address - Phone:210-858-7604
Practice Address - Fax:210-888-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty