Organization
KIDNEY TREATMENT CENTER NORTHWEST P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA J MEDOLA (SUPERVISOR)
(210) 692-1515
Entity
Organization
Contact information
Practice address
3939 MEDICAL DR, STE 110, SAN ANTONIO, TX 78229-2292
(210) 692-3075
(210) 692-0187
Mailing address
3939 MEDICAL DR, STE 110, SAN ANTONIO, TX 78229-2292
(210) 692-1515
(210) 692-0187
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
007316
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0943250-02
—
TX
05
—
1452880-02
—
TX
01
—
HH6407
BCBS
TX
Enumeration date
06/08/2005
Last updated
01/25/2012
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