MEDICARE: NORTH TEXAS KIDNEY DISEASE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154777068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS KIDNEY DISEASE ASSOCIATES

Provider Business Mailing Address
First Line	:	1600 WATERS RIDGE DR STE A
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-6039
Country	:	US
Telephone Number	:	972-219-0558
Fax Number	:	214-466-7237

Provider Business Practice Location Address
First Line	:	4333 N JOSEY LN STE 103
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4620
Country	:	US
Telephone Number	:	972-219-0558
Fax Number	:	972-436-9273

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	SIRENA MARTIN
Credential	:
Telephone Number	:	214-466-7230

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	07/17/2024

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