Provider Demographics
NPI:1972532893
Name:KIDNEY DOCTORS OF SOUTH TEXAS PA
Entity Type:Organization
Organization Name:KIDNEY DOCTORS OF SOUTH TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-519-2315
Mailing Address - Street 1:PO BOX 4412
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4412
Mailing Address - Country:US
Mailing Address - Phone:956-519-2315
Mailing Address - Fax:956-519-0483
Practice Address - Street 1:1300 S BRYAN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6626
Practice Address - Country:US
Practice Address - Phone:956-519-2315
Practice Address - Fax:956-519-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180044303Medicaid
0056NTOtherBLUE CROSS BLUE SHIELD
TXDE8323OtherRAILROAD MEDICARE
0056NTOtherBLUE CROSS BLUE SHIELD
TX180044302Medicaid