Provider Demographics
NPI:1629107404
Name:NORTH TEXAS NEPHROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:NORTH TEXAS NEPHROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:N
Authorized Official - Last Name:MELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-265-9700
Mailing Address - Street 1:1132 S BOWEN RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2204
Mailing Address - Country:US
Mailing Address - Phone:817-265-9700
Mailing Address - Fax:
Practice Address - Street 1:1132 S BOWEN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2204
Practice Address - Country:US
Practice Address - Phone:817-265-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082705701Medicaid
CK6724OtherRAILROAD MEDICARE
TX00G62LOtherMEDICARE ID