MEDICARE: NORTH TEXAS RENAL SERVICES, LLC

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	332BD1200X	Dialysis Equipment & Supplies (DME)	0081045	TX

General Provider Information

NPI Number	:	1093798035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS RENAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	4309 MESA DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207-3457
Country	:	US
Telephone Number	:	940-566-2701
Fax Number	:	940-382-2558

Provider Business Practice Location Address
First Line	:	4309 MESA DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207-3457
Country	:	US
Telephone Number	:	940-566-2701
Fax Number	:	940-382-2558

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAN MICHAEL CORPANY
Credential	:	BS,PA,CNT
Telephone Number	:	940-566-2701

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	08/22/2020

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Directions to “NORTH TEXAS RENAL SERVICES, LLC ” Practice Location

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