Provider Demographics
NPI:1720275399
Name:SOUTH PLAINS RENAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH PLAINS RENAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-580-9100
Mailing Address - Street 1:12834 WILLOW CENTRE DR STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-3047
Mailing Address - Country:US
Mailing Address - Phone:281-580-9100
Mailing Address - Fax:281-580-9577
Practice Address - Street 1:12834 WILLOW CENTRE DR STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-3047
Practice Address - Country:US
Practice Address - Phone:281-580-9100
Practice Address - Fax:281-580-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8339207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty