1356362461 NPI number — NORTH TEXAS KIDNEY CARE ASSOCIATES

Table of content: (NPI 1356362461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356362461 NPI number — NORTH TEXAS KIDNEY CARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS KIDNEY CARE ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356362461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75019-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-529-0255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 W PLEASANT RUN RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75146-1079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-230-8881
Provider Business Practice Location Address Fax Number:
972-230-8810
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KALU
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
CHUKWUDI
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
214-529-0255

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  J5226 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0077PN . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 189244001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DO3893 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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