Basic Information
| Provider Information | |||||||||
| NPI: | 1093995508 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARLITE SOUTHWEST KIDNEY CENTER | ||||||||
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| OtherOrganizationName: | BARLITE SOUTHWEST KIDNEY CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7500 BARLITE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782241362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109223377 | ||||||||
| FaxNumber: | 2109222311 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 BARLITE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782241362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109223377 | ||||||||
| FaxNumber: | 2109222311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2007 | ||||||||
| LastUpdateDate: | 11/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | SZEWE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2109223377 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.