Provider Demographics
NPI:1861507964
Name:AMARILLO NEPHROLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:AMARILLO NEPHROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-418-8620
Mailing Address - Street 1:1805 POINT WEST PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2165
Mailing Address - Country:US
Mailing Address - Phone:806-418-8620
Mailing Address - Fax:806-418-8626
Practice Address - Street 1:1805 POINT WEST PKWY STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2166
Practice Address - Country:US
Practice Address - Phone:806-418-8620
Practice Address - Fax:806-418-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP3437OtherNEW MEXICO MEDICAID
TXCE1123OtherRR MEDICARE
TXZ00008AZ4Medicaid
TX00008AZOtherTEXAS BLUE CROSS BLUE SHI
NMP3437OtherNEW MEXICO MEDICAID