Provider Demographics
NPI:1992889596
Name:TEXARKANA KIDNEY DISEASE & HYPERTENSION CENTER, INC
Entity type:Organization
Organization Name:TEXARKANA KIDNEY DISEASE & HYPERTENSION CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:D.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-773-1111
Mailing Address - Street 1:422 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5310
Mailing Address - Country:US
Mailing Address - Phone:870-773-1111
Mailing Address - Fax:870-772-7692
Practice Address - Street 1:407 W 16TH ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-7104
Practice Address - Country:US
Practice Address - Phone:870-777-1700
Practice Address - Fax:870-777-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158823134Medicaid