Provider Demographics
NPI:1396848313
Name:GREATER HOUSTON KIDNEY SPECIALISTS LLP
Entity type:Organization
Organization Name:GREATER HOUSTON KIDNEY SPECIALISTS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSOUAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-6209
Mailing Address - Street 1:7447 CAMBRIDGE ST #111
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054
Mailing Address - Country:US
Mailing Address - Phone:713-790-6209
Mailing Address - Fax:713-793-7555
Practice Address - Street 1:10023 SOUTH MAIN SUITE C-9
Practice Address - Street 2:MAIN MEDICAL PLAZA
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:713-496-1077
Practice Address - Fax:713-791-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171678901Medicaid
TX00643WMedicare ID - Type Unspecified