1063457240 NPI number — RENAL CENTER OF NORTH DENTON, LLLP

Table of content: (NPI 1063457240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063457240 NPI number — RENAL CENTER OF NORTH DENTON, LLLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL CENTER OF NORTH DENTON, LLLP
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:
1063457240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 VIRGINIA WAY
Provider Second Line Business Mailing Address:
L&C DEPARTMENT
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-341-6764
Provider Business Mailing Address Fax Number:
833-781-6999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4309 MESA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76207-3438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-566-2701
Provider Business Practice Location Address Fax Number:
940-483-8251
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINSTEL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ACCOUNTING OFFICER
Authorized Official Telephone Number:
253-733-4501

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  008212 , 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: 0942492-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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