Provider Demographics
NPI:1467940759
Name:NORTH TEXAS NEPHROLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NORTH TEXAS NEPHROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-265-9700
Mailing Address - Street 1:1132 SOUTH BOWEN ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013
Mailing Address - Country:US
Mailing Address - Phone:817-265-9700
Mailing Address - Fax:817-277-4164
Practice Address - Street 1:1132 SOUTH BOWEN ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013
Practice Address - Country:US
Practice Address - Phone:817-265-9700
Practice Address - Fax:817-277-4164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH TEXAS NEPHROLOGY ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136538363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082705701Medicaid