Provider Demographics
NPI:1134455256
Name:RICHARD A NICHOLS, DPM, PA
Entity type:Organization
Organization Name:RICHARD A NICHOLS, DPM, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
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:8174-814-0000
Mailing Address - Street 1:1600 LANCASTER DR
Mailing Address - Street 2:SUITE 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 1:1141 KELLER PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1627
Practice Address - Country:US
Practice Address - Phone:817-741-4800
Practice Address - Fax:817-741-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX917213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5551220003Medicare NSC
TX00762KMedicare UPIN