NPIMap

Organization Active NPI

North Texas Kidney Disease Associates

  • Nephrology Physician
  • Carrollton, TX
National Provider Identifier
1790809036
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTH TEXAS KIDNEY DISEASE ASSOCIATES
Practice address
4240 International Pkwy
Ste. 154
Carrollton, TX 75007
Phone
(469) 574-0464
Fax
(469) 574-0471
NPI assigned
Mar 19, 2007
Last updated
Jul 12, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH TEXAS KIDNEY DISEASE ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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

Authorized official

Name
Tammy Vaughn
Title
Credentialing Coordinator
Phone
(940) 320-1708

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

4240 International Pkwy
Ste. 154
Carrollton, TX 75007

Mailing address

3315 Colorado Blvd Ste 102
Denton, TX 76210-6885
Phone (940) 320-1708

Other identifiers 1

IdentifierTypeStateIssuer
146883702MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
North Texas Kidney Disease10 organizations share this tax ID, including this one
Part of
North Texas Kidney Disease

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4240 International Pkwy
Ste 154
Carrollton, TX 75007
Phone (469) 574-0464

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1790809036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3315 COLORADO BLVD STE 102",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762106885",
            "telephone_number": "940-320-1708",
            "fax_number": "940-565-5457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4240 INTERNATIONAL PKWY",
            "address_2": "STE. 154",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "75007",
            "telephone_number": "469-574-0464",
            "fax_number": "469-574-0471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH TEXAS KIDNEY DISEASE ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH TEXAS KIDNEY DISEASE ASSOCIATES",
        "enumeration_date": "2007-03-19",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "940-320-1708"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146883702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; 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.