Provider Demographics
NPI:1184894271
Name:GREENVILLE NEPHROLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:GREENVILLE NEPHROLOGY ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-668-9713
Mailing Address - Street 1:4085 OHIO DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6240
Mailing Address - Country:US
Mailing Address - Phone:972-668-9713
Mailing Address - Fax:214-446-9460
Practice Address - Street 1:4085 OHIO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6240
Practice Address - Country:US
Practice Address - Phone:972-668-9713
Practice Address - Fax:214-446-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1218207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178616201Medicaid
TXF11695Medicare UPIN
TX178616201Medicaid