Kidney Treatment Center East P a

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

007035 Issued in TX

Legal business name

KIDNEY TREATMENT CENTER EAST P A

Practice address

1608 S New Braunfels Ave
San Antonio, TX 78210-2253

Phone

(210) 531-9522

Fax

(210) 531-9817

NPI assigned

Jun 8, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jessica J Medola

Title

Supervisor

Phone

(210) 692-1515

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bruce Albert Brockway, MD

  • Nephrology Physician
  • San Antonio, TX
  • NPI 1336221555
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1699779611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 MEDICAL DR",
            "address_2": "# 110",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782292291",
            "telephone_number": "210-692-1515",
            "fax_number": "210-692-0187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1608 S NEW BRAUNFELS AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782102253",
            "telephone_number": "210-531-9522",
            "fax_number": "210-531-9817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY TREATMENT CENTER EAST P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "MEDOLA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "210-692-1515",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "TX",
            "license": "007035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0943250-01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0943250-02",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "HH6395",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kidney and Wellness Center PLLC
• Kidney Treatment Center Northwest P a
• Kidney Treatment Center San Antonio Inc
• Kids Smile, PC
• Kids Teeth, PLLC
• Kids World Pediatric Dentistry

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in San Antonio, TX
• Providers in San Antonio, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.