Provider Demographics
NPI:1053413187
Name:AMARILLO KIDNEY SPECIALISTS, LLC
Entity type:Organization
Organization Name:AMARILLO KIDNEY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-358-0051
Mailing Address - Street 1:8604 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-7379
Mailing Address - Country:US
Mailing Address - Phone:806-358-0051
Mailing Address - Fax:806-355-0410
Practice Address - Street 1:8604 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-7379
Practice Address - Country:US
Practice Address - Phone:806-358-0051
Practice Address - Fax:806-355-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007962261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160987702Medicaid
TX160987701Medicaid
TX452866Medicare ID - Type Unspecified