Provider Demographics
NPI:1295915338
Name:TEXAS INSTITUTE FOR KIDNEY AND ENDOCRINE DISORDERS, PA
Entity type:Organization
Organization Name:TEXAS INSTITUTE FOR KIDNEY AND ENDOCRINE DISORDERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-632-4282
Mailing Address - Street 1:PO BOX 152837
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-2837
Mailing Address - Country:US
Mailing Address - Phone:936-462-7844
Mailing Address - Fax:936-462-7855
Practice Address - Street 1:10 MEDICAL CENTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3163
Practice Address - Country:US
Practice Address - Phone:936-632-4282
Practice Address - Fax:936-632-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0822207RN0300X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201207202Medicaid
TX0103RMOtherBLUE CROSS BLUE SHIELD
TXDO7758OtherRAILROAD MEDICARE
TX201207201Medicaid
TX201207202Medicaid
TX136236004Medicaid
TX00365YMedicare PIN
TXDO7758OtherRAILROAD MEDICARE
TX136236008Medicaid
TX201207202Medicaid