Provider Demographics
NPI:1972038362
Name:RENAL CLINIC OF HOUSTON
Entity type:Organization
Organization Name:RENAL CLINIC OF HOUSTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VERMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-214-0462
Mailing Address - Street 1:2222 GREENHOUSE RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7287
Mailing Address - Country:US
Mailing Address - Phone:713-464-9100
Mailing Address - Fax:
Practice Address - Street 1:2222 GREENHOUSE RD
Practice Address - Street 2:SUITE 15
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7287
Practice Address - Country:US
Practice Address - Phone:713-464-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL CLINIC OF HOUSTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4410207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G7263Medicare PIN
TXP00631602Medicare PIN
TX8G7263Medicare UPIN