Provider Demographics
NPI:1356362461
Name:NORTH TEXAS KIDNEY CARE ASSOCIATES
Entity type:Organization
Organization Name:NORTH TEXAS KIDNEY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:CHUKWUDI
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-529-0255
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-1157
Mailing Address - Country:US
Mailing Address - Phone:214-529-0255
Mailing Address - Fax:
Practice Address - Street 1:2700 W PLEASANT RUN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1079
Practice Address - Country:US
Practice Address - Phone:972-230-8881
Practice Address - Fax:972-230-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5226207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077PNOtherBCBS
TX189244001Medicaid
DO3893OtherMEDICARE RAILROAD
DO3893OtherMEDICARE RAILROAD