Clinical Nephrology Associates, PA

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

CLINICAL NEPHROLOGY ASSOCIATES, PA

Practice address

1700 Mistletoe Blvd
Fort Worth, TX 76104-4042

Phone

(817) 923-8050

Fax

(817) 923-8832

NPI assigned

Jun 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jack Orrin Gratch, DO

Title

Ceo

Phone

(817) 923-8050

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315440000000",
    "number": "1184669673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 470787",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761470787",
            "telephone_number": "817-923-8050",
            "fax_number": "817-923-8832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MISTLETOE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044042",
            "telephone_number": "817-923-8050",
            "fax_number": "817-923-8832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL NEPHROLOGY ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2011-09-08",
        "status": "A",
        "authorized_official_last_name": "GRATCH",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "ORRIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-923-8050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "00T17Z",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085155202",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CT1051",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Andryce Clinkscales
• Shalin Clonch

• Nephrology Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Nephrology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; 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.