Healthcare Provider Details

I. General information

NPI: 1992889596
Provider Name (Legal Business Name): TEXARKANA KIDNEY DISEASE & HYPERTENSION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W 16TH ST
HOPE AR
71801-7104
US

IV. Provider business mailing address

422 BEECH ST
TEXARKANA AR
71854-5310
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-1700
  • Fax: 870-777-1701
Mailing address:
  • Phone: 870-773-1111
  • Fax: 870-772-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. D. MICHAEL BLANKENSHIP
Title or Position: PRESIDENT
Credential: MD
Phone: 870-773-1111