Provider Demographics
NPI:1306111877
Name:COMPREHENSIVE KIDNEY INSTITUTE OF WEST TEXAS
Entity type:Organization
Organization Name:COMPREHENSIVE KIDNEY INSTITUTE OF WEST TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:432-558-0497
Mailing Address - Street 1:3323 N MIDLAND DR
Mailing Address - Street 2:SUITE 113-106
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4608
Mailing Address - Country:US
Mailing Address - Phone:432-558-0497
Mailing Address - Fax:432-558-0498
Practice Address - Street 1:318 N ALLEGHANEY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5052
Practice Address - Country:US
Practice Address - Phone:432-558-0497
Practice Address - Fax:432-558-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-17
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0787207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty