Provider Demographics
NPI:1194172403
Name:KIDNEY & HYPERTENSION GROUP OF LAREDO PLLC
Entity type:Organization
Organization Name:KIDNEY & HYPERTENSION GROUP OF LAREDO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-796-1390
Mailing Address - Street 1:1710 E SAUNDERS ST
Mailing Address - Street 2:STE B675
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-724-3108
Mailing Address - Fax:956-796-9495
Practice Address - Street 1:1710 E SAUNDERS ST
Practice Address - Street 2:STE B675
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-724-3108
Practice Address - Fax:956-796-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7745207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1518283688OtherNPI