Basic Information
| Provider Information | |||||||||
| NPI: | 1811195274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER HOUSTON NEPHROLOGY NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8876 GULF FWY | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770176513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139479509 | ||||||||
| FaxNumber: | 7139470609 | ||||||||
| Practice Location | |||||||||
| Address1: | 8876 GULF FWY | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770176513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139479509 | ||||||||
| FaxNumber: | 7139470609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAUGANS | ||||||||
| AuthorizedOfficialFirstName: | WADE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7139479509 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.