Provider Demographics
NPI:1992823025
Name:NORTH SHEPHERD KIDNEY CLINIC, INC.
Entity Type:Organization
Organization Name:NORTH SHEPHERD KIDNEY CLINIC, INC.
Other - Org Name:NORTH SHEPHERD KIDNEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WADI
Authorized Official - Middle Name:N
Authorized Official - Last Name:SUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-790-9080
Mailing Address - Street 1:7272 N SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-2435
Mailing Address - Country:US
Mailing Address - Phone:713-697-1115
Mailing Address - Fax:713-697-1116
Practice Address - Street 1:7272 N SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-2435
Practice Address - Country:US
Practice Address - Phone:713-697-1115
Practice Address - Fax:713-697-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
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
TX1770885Medicaid
TX1770885Medicaid