Provider Demographics
NPI:1083806533
Name:NTKC MANAGEMENT, LLC
Entity type:Organization
Organization Name:NTKC MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-375-0610
Mailing Address - Street 1:3030 MATLOCK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2935
Mailing Address - Country:US
Mailing Address - Phone:817-375-0610
Mailing Address - Fax:817-375-0640
Practice Address - Street 1:4351 BOOTH CALLOWAY RD
Practice Address - Street 2:SUITE 404
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7378
Practice Address - Country:US
Practice Address - Phone:817-870-9941
Practice Address - Fax:817-870-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty