Provider Demographics
NPI:1063654515
Name:NTKC MANAGEMENT, LLC
Entity Type:Organization
Organization Name:NTKC MANAGEMENT, LLC
Other - Org Name:NORTH TEXAS KIDNEY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-375-0610
Mailing Address - Street 1:3030 MATLOCK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2935
Mailing Address - Country:US
Mailing Address - Phone:817-375-0610
Mailing Address - Fax:817-375-0640
Practice Address - Street 1:805 HILL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1481
Practice Address - Country:US
Practice Address - Phone:817-375-0610
Practice Address - Fax:817-375-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty