Provider Demographics
NPI:1427005842
Name:DALLAS KIDNEY SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:DALLAS KIDNEY SPECIALISTS, P.A.
Other - Org Name:DALLAS KIDNEY SPECIALISTS, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-638-6600
Mailing Address - Street 1:1341 W. MOCKINGBIRD LANE
Mailing Address - Street 2:SUITE 240E
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4971
Mailing Address - Country:US
Mailing Address - Phone:214-638-6600
Mailing Address - Fax:214-638-6618
Practice Address - Street 1:1341 W. MOCKINGBIRD LANE
Practice Address - Street 2:SUITE 240E
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4971
Practice Address - Country:US
Practice Address - Phone:214-638-6600
Practice Address - Fax:214-638-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L19LMedicare ID - Type Unspecified
TXOOL19LMedicare PIN