Provider Demographics
NPI:1780007435
Name:KIDNEY CENTER OF WALKER COUNTY LLC
Entity Type:Organization
Organization Name:KIDNEY CENTER OF WALKER COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHURANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-294-0971
Mailing Address - Street 1:102 MEDICAL PARK LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4975
Mailing Address - Country:US
Mailing Address - Phone:936-294-0971
Mailing Address - Fax:936-294-0977
Practice Address - Street 1:102 MEDICAL PARK LN
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4975
Practice Address - Country:US
Practice Address - Phone:936-294-0971
Practice Address - Fax:936-294-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1828207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty