Texoma Kidney Care, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G0858 Issued in TX

Legal business name

TEXOMA KIDNEY CARE, P.A.

Practice address

201 Memorial Dr
Suite 201
Denison, TX 75020-2026

Phone

(903) 463-5057

Fax

(903) 463-7661

NPI assigned

May 17, 2006

Organization subpart

No

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

Authorized official

Name

Glen Robert Willie, M.D.NPI 1205887973

Title

President

Phone

(903) 463-5057

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Glen Robert Willie, MD

  • Internal Medicine Physician
  • Denison, TX
  • NPI 1205887973

  Specialist

  NPD (past) Authorized official
• Douglas Paul Myers, M.D.

  • Specialist
  • Denison, TX
  • NPI 1457302127
  NPD

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1306898374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 MEMORIAL DR",
            "address_2": "SUITE 201",
            "city": "DENISON",
            "state": "TX",
            "postal_code": "750202026",
            "telephone_number": "903-463-5057",
            "fax_number": "903-463-7661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MEMORIAL DR",
            "address_2": "SUITE 201",
            "city": "DENISON",
            "state": "TX",
            "postal_code": "750202026",
            "telephone_number": "903-463-5057",
            "fax_number": "903-463-7661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXOMA KIDNEY CARE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "WILLIE",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-463-5057",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "G0858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OK RAILROAD MEDICARE",
            "identifier": "DF3764",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "0031EE",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Texoma Brain and Spine Surgery, PLLC
• Texoma Emergency Physicians PLLC
• Texoma Foot and Ankle Specialists PA
• Texoma Heart Group, PA
• Texoma Interstate Ventures
• Texoma Liver Center PLLC
• Texoma Nephrology Associates
• Texoma Orthopedic and Spine PLLC
• Texoma Psychological Services PLLC
• Texoma Pulmonary & Sleep Specialist PA

• Specialist in Denison, TX
• Providers in Denison, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; 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.