Organization
CLINICAL NEPHROLOGY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK GRATCH DO (OWNER/CEO)
(817) 923-8050
Entity
Organization
Contact information
Practice address
11797 SOUTH FWY, SUITE 226, BURLESON, TX 76028-7026
(817) 923-8050
(817) 923-8832
Mailing address
PO BOX 470787, FORT WORTH, TX 76147-0787
(817) 923-8050
(817) 923-8832
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
F8496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085155204
—
TX
Enumeration date
01/31/2013
Last updated
01/31/2013
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