Provider Demographics
NPI:1013240548
Name:SOUTHWEST NEPHROLOGY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:SOUTHWEST NEPHROLOGY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRUMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-270-4545
Mailing Address - Street 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:STE.# 304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1802
Mailing Address - Country:US
Mailing Address - Phone:713-270-4545
Mailing Address - Fax:713-270-9197
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:STE.# 304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-270-4545
Practice Address - Fax:713-270-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BH04OtherMEDICARE #
TX114217602Medicaid
TXP00BH046OtherMEDICAID (TPI & RR)