Provider Demographics
NPI:1801032552
Name:JENSEN KIDNEY CLINIC, INC.
Entity Type:Organization
Organization Name:JENSEN KIDNEY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-433-4792
Mailing Address - Street 1:9716 JENSEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77093-6302
Mailing Address - Country:US
Mailing Address - Phone:281-433-4792
Mailing Address - Fax:
Practice Address - Street 1:9716 JENSEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-6302
Practice Address - Country:US
Practice Address - Phone:281-433-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF67546Medicare UPIN
TXI67287Medicare UPIN
TXH36032Medicare UPIN
TXG28741Medicare UPIN
TXI20691Medicare UPIN
TXE38992Medicare UPIN
TXB26770Medicare UPIN
TXH36191Medicare UPIN
TXG03956Medicare UPIN
TXI05365Medicare UPIN
TXG88585Medicare UPIN