1154875839 NPI number — NORTH TEXAS KIDNEY DISEASE ASSOCIATES

Table of content: CAM TU HO WAGNER ARNP (NPI 1407101884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154875839 NPI number — NORTH TEXAS KIDNEY DISEASE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS KIDNEY DISEASE 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:
1154875839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3315 COLORADO BLVD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-6884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-320-1708
Provider Business Mailing Address Fax Number:
940-565-5457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4708 ALLIANCE BLVD STE 685
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-466-7230
Provider Business Practice Location Address Fax Number:
214-466-7236
Provider Enumeration Date:
08/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VAUGHN
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
940-320-1708

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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