Provider Demographics
NPI:1699778068
Name:KIDNEY SPECIALISTS OF SOUTH TEXAS, P.A.
Entity type:Organization
Organization Name:KIDNEY SPECIALISTS OF SOUTH TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-887-8451
Mailing Address - Street 1:850 W RIO SALADO PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3812
Mailing Address - Country:US
Mailing Address - Phone:361-887-8451
Mailing Address - Fax:361-887-6126
Practice Address - Street 1:1521 S STAPLES ST
Practice Address - Street 2:STE 601
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3154
Practice Address - Country:US
Practice Address - Phone:361-887-8451
Practice Address - Fax:361-887-6126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109425201Medicaid
TX109425201Medicaid