Provider Demographics
NPI:1992002547
Name:SAN ANTONIO KIDNEY DISEASE CENTER PHYSICIANS GROUP, P.L.L.C.
Entity Type:Organization
Organization Name:SAN ANTONIO KIDNEY DISEASE CENTER PHYSICIANS GROUP, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-661-5622
Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6256
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-481-7463
Practice Address - Street 1:9846 WESTOVER HILLS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4125
Practice Address - Country:US
Practice Address - Phone:210-403-0765
Practice Address - Fax:210-547-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty