Provider Demographics
NPI:1154777068
Name:NORTH TEXAS KIDNEY DISEASE ASSOCIATES
Entity type:Organization
Organization Name:NORTH TEXAS KIDNEY DISEASE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-466-7230
Mailing Address - Street 1:1600 WATERS RIDGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6039
Mailing Address - Country:US
Mailing Address - Phone:972-219-0558
Mailing Address - Fax:214-466-7237
Practice Address - Street 1:4333 N JOSEY LN STE 103
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4620
Practice Address - Country:US
Practice Address - Phone:972-219-0558
Practice Address - Fax:972-436-9273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH TEXAS KIDNEY DISEASE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-10
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146883702Medicaid
TX00672RMedicare PIN