NPIMap

Organization Active NPI

East Texas Kidney Specialists,PA

Doing business as East Texas Kidney Specialists

  • Nephrology Physician
  • Longview, TX
National Provider Identifier
1184689622
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
EAST TEXAS KIDNEY SPECIALISTS,PA
Doing business as
East Texas Kidney Specialists
Practice address
3535 N Fourth St Ste 301
Longview, TX 75605-0037
Phone
(903) 234-9992
Fax
(903) 234-8287
NPI assigned
Apr 18, 2006
Last updated
Oct 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Authorized official

Name
Ms. Tiffany Hagood
Title
Practice Administrator
Phone
(903) 234-9992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

3535 N Fourth St Ste 301
Longview, TX 75605-0037

Mailing address

3535 N Fourth St Ste 301
Longview, TX 75605-0037
Phone (903) 234-9992

Other identifiers 1

IdentifierTypeStateIssuer
0035GNOtherTXBLUE CROSS & BLUE SHIELD

Other names 1

  • EAST TEXAS KIDNEY SPECIALISTS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050128000103 TX Part B Supplier - Clinic/Group Practice 6901856806 Receives reassigned benefits from 11 practitioners
Practice locations: Longview, TX

National Provider Directory

National Provider Directory

Locations

3101 4th St
Ste A
Longview, TX 75605
Phone (903) 758-3401

3535 N Fourth St
Ste 301
Longview, TX 75605
Phone (903) 234-9992

425 N Fredonia St
Ste 100A
Longview, TX 75601
Phone (903) 234-9992

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633478400000",
    "number": "1184689622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 301",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050037",
            "telephone_number": "903-234-9992",
            "fax_number": "903-234-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 301",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050037",
            "telephone_number": "903-234-9992",
            "fax_number": "903-234-8287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS KIDNEY SPECIALISTS,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A",
        "authorized_official_last_name": "HAGOOD",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "903-234-9992",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "0035GN",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAST TEXAS KIDNEY SPECIALISTS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EAST TEXAS KIDNEY SPECIALISTS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.