Provider Demographics
NPI:1932335361
Name:COASTAL-KIDNEY TREATMENT CENTERS PLLC
Entity Type:Organization
Organization Name:COASTAL-KIDNEY TREATMENT CENTERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-558-6555
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:# 214
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2432
Mailing Address - Country:US
Mailing Address - Phone:281-558-6555
Mailing Address - Fax:281-558-6133
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:# 561
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-558-6555
Practice Address - Fax:281-558-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0053SDOtherBCBSTX GROUP #
TX0053SDOtherBCBSTX GROUP #