Provider Demographics
NPI:1508067331
Name:TEXARKANA KIDNEY DISEASE & HYPERTENSION CENTER, INC.
Entity type:Organization
Organization Name:TEXARKANA KIDNEY DISEASE & HYPERTENSION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-773-1111
Mailing Address - Street 1:422 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5310
Mailing Address - Country:US
Mailing Address - Phone:870-773-1111
Mailing Address - Fax:870-772-7692
Practice Address - Street 1:422 BEECH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5310
Practice Address - Country:US
Practice Address - Phone:870-773-1111
Practice Address - Fax:870-772-7692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID