Provider Demographics
NPI:1861416117
Name:GULF COAST NEPHROLOGY LLP
Entity type:Organization
Organization Name:GULF COAST NEPHROLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-297-2220
Mailing Address - Street 1:450 THIS WAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5152
Mailing Address - Country:US
Mailing Address - Phone:979-299-0091
Mailing Address - Fax:713-988-8662
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:SUITE 1052
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-988-8776
Practice Address - Fax:713-988-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168436702Medicaid
TX209870901Medicaid
TX208541701Medicaid
TX208541701Medicaid
0A5129Medicare PIN
TX00973WMedicare PIN