Provider Demographics
NPI:1588774087
Name:SOUTHWEST NEPHROLOGY ASSOCIATES, LLP
Entity type:Organization
Organization Name:SOUTHWEST NEPHROLOGY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIALIZA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-270-4545
Mailing Address - Street 1:7777 SW FREEWAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-270-4545
Mailing Address - Fax:713-270-9197
Practice Address - Street 1:7777 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-270-4545
Practice Address - Fax:713-270-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082789101Medicaid
TX082789101Medicaid