Provider Demographics
NPI:1356566194
Name:RENAL CARE CONSULTANT, P.A
Entity type:Organization
Organization Name:RENAL CARE CONSULTANT, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WASEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-558-8260
Mailing Address - Street 1:11152 WESTHEIMER ROAD
Mailing Address - Street 2:# 702
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3208
Mailing Address - Country:US
Mailing Address - Phone:281-558-8260
Mailing Address - Fax:281-531-8087
Practice Address - Street 1:12051 WEST PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5556
Practice Address - Country:US
Practice Address - Phone:281-558-8260
Practice Address - Fax:281-531-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159588601Medicaid
TX5622189OtherAETNA
TX390343OtherWELLCARE
TX5000634OtherCIGNA
TX10011273OtherAMERIGROUP
TX8H8370OtherBLUE CROSS BLUE SHEILD
TXP00028850OtherRAILROAD MEDICARE
TX86872ZOtherBCBS HMO
TXMDL0902OtherWORKERS COMP
TX5622189OtherAETNA
TXG06176Medicare UPIN