Provider Demographics
NPI:1083804298
Name:RICHARD A. NICHOLS D P M P A
Entity Type:Organization
Organization Name:RICHARD A. NICHOLS D P M P A
Other - Org Name:ALLIANCE FOOT AND ANKLE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-481-4000
Mailing Address - Street 1:1600 LANCASTER DR
Mailing Address - Street 2:STE 102
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3579
Mailing Address - Country:US
Mailing Address - Phone:817-481-4000
Mailing Address - Fax:817-421-0732
Practice Address - Street 1:1600 LANCASTER DR
Practice Address - Street 2:STE 102
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3579
Practice Address - Country:US
Practice Address - Phone:817-481-4000
Practice Address - Fax:817-421-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00762KMedicare PIN
T15038Medicare UPIN
5551220001Medicare NSC