East Texas Nephrology Association

Primary specialty

SpecialistTaxonomy code 174400000X

License

H8527 Issued in TX

Legal business name

EAST TEXAS NEPHROLOGY ASSOCIATION

Practice address

700 S Fleishel Ave
Tyler, TX 75701-2014

Phone

(903) 526-6374

Fax

(903) 526-4578

NPI assigned

Aug 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Molly Mae Bankhead, M.D.NPI 1043278187

Title

President

Phone

(903) 526-6374

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 1

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

• Molly May Bankhead, M.D.

  • Nephrology Physician
  • Arp, TX
  • NPI 1043278187
  NPD (past) Authorized official

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497860449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012014",
            "telephone_number": "903-526-6374",
            "fax_number": "903-526-4578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012014",
            "telephone_number": "903-526-6374",
            "fax_number": "903-526-4578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS NEPHROLOGY ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BANKHEAD",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-526-6374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "H9769",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "H8527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0086HD",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Texas Medical Center Rehabilitation Hospital
• East Texas Medical Center Specialty Hospital
• East Texas Medical Center Tyler
• East Texas Medical Home Services
• East Texas Mental Health Associates
• East Texas Neurology
• East Texas Omfs Trauma Consultants, PLLC
• East Texas Pediatric Rehabilitation Associates Inc
• East Texas Physician Assistant Services
• East Texas Podiatry Associates, P.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.