Provider Demographics
NPI:1194103382
Name:HEALING KIDNEYS INSTITUTE OF HOUSTON PLLC
Entity type:Organization
Organization Name:HEALING KIDNEYS INSTITUTE OF HOUSTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVILATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VUPPALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-610-2822
Mailing Address - Street 1:200 S RIVERSHIRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3485
Mailing Address - Country:US
Mailing Address - Phone:832-610-2822
Mailing Address - Fax:936-777-8831
Practice Address - Street 1:200 S RIVERSHIRE DR STE 300
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3485
Practice Address - Country:US
Practice Address - Phone:832-610-2822
Practice Address - Fax:936-777-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209330403Medicaid