Provider Demographics
NPI:1942694146
Name:KIDNEY HYPERTENSION TRANSPLANT CLINIC OF CLEAR LAKE PLLC
Entity Type:Organization
Organization Name:KIDNEY HYPERTENSION TRANSPLANT CLINIC OF CLEAR LAKE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-724-1860
Mailing Address - Street 1:500 N KOBAYASHI STE A
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4722
Mailing Address - Country:US
Mailing Address - Phone:281-724-1860
Mailing Address - Fax:281-724-1861
Practice Address - Street 1:500 N KOBAYASHI STE A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4722
Practice Address - Country:US
Practice Address - Phone:281-724-1860
Practice Address - Fax:281-724-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8192207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1063413235OtherNPI