NPIMap

Organization Active NPI

Suresh Kankanala M.D, P.a.

  • Primary Care Clinic/Center
  • Fort Worth, TX
National Provider Identifier
1053762237
Registry record updated Aug 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
N5145 Issued in TX
Legal business name
SURESH KANKANALA M.D, P.A.
Practice address
923 College Ave
Suite 103
Fort Worth, TX 76104-3050
Phone
(972) 544-6600
NPI assigned
Jun 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Suresh Babu Kankanala, M.DNPI 1922211697
Title
President
Phone
(972) 544-6600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Primary Care Clinic/Center 261QP2300X N5145 TX Primary
General Acute Care Hospital 282N00000X N5145 TX

Addresses

Primary practice location

923 College Ave
Suite 103
Fort Worth, TX 76104-3050

Mailing address

923 College Ave
Suite 103
Fort Worth, TX 76104-3050

National Provider Directory

National Provider Directory

Locations

923 College Ave
Ste 103
Fort Worth, TX 76104
Phone (817) 293-3000

923 College Ave
Ste 101
Fort Worth, TX 76104
Phone (817) 697-4038

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470614400000",
    "number": "1053762237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "923 COLLEGE AVE",
            "address_2": "SUITE 103",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 COLLEGE AVE",
            "address_2": "SUITE 103",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043050",
            "telephone_number": "972-544-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURESH KANKANALA M.D, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-28",
        "last_updated": "2016-08-08",
        "status": "A",
        "authorized_official_last_name": "KANKANALA",
        "authorized_official_first_name": "SURESH",
        "authorized_official_middle_name": "BABU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-544-6600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "N5145",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "N5145",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.