Provider Demographics
NPI:1760649206
Name:NEPHROLOGY LEADERS AND ASSOCIATES, PLLC
Entity type:Organization
Organization Name:NEPHROLOGY LEADERS AND ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:ATIQ
Authorized Official - Last Name:DATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-245-2421
Mailing Address - Street 1:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77404-2660
Mailing Address - Country:US
Mailing Address - Phone:979-245-2421
Mailing Address - Fax:979-245-6263
Practice Address - Street 1:200 MEDICAL CENTER CT STE 100
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4733
Practice Address - Country:US
Practice Address - Phone:979-245-2421
Practice Address - Fax:979-245-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0080RLOtherBCBS OF TX
TX197861102Medicaid