Provider Demographics
NPI:1023342532
Name:ABILENE KIDNEY CLINIC, P.A.
Entity type:Organization
Organization Name:ABILENE KIDNEY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-670-4494
Mailing Address - Street 1:1904 PINE ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2449
Mailing Address - Country:US
Mailing Address - Phone:325-670-4494
Mailing Address - Fax:325-670-4497
Practice Address - Street 1:1904 PINE ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2449
Practice Address - Country:US
Practice Address - Phone:325-670-4494
Practice Address - Fax:325-670-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty