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General NPI Number Information
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NPI Number | 1154777068
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS KIDNEY DISEASE ASSOCIATES
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 4333 N JOSEY LN STE 103
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City | CARROLLTON
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State | TX
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Zip | 75010-4620
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Country | US
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Telephone | 972-219-0558
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Fax | 972-436-9273
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Provider Business Mailing Address
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Address Line | 1600 WATERS RIDGE DR STE A
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City | LEWISVILLE
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State | TX
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Zip | 75057-6039
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Country | US
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Telephone | 972-219-0558
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Fax | 214-466-7237
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SIRENA MARTIN
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Credential |
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Telephone | 214-466-7230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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