Organization
CLINICAL NEPHROLOGY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK O GRATCH DO (CEO)
(817) 927-2612
Entity
Organization
Contact information
Practice address
920 SANTA FE DR, SUITE 103, WEATHERFORD, TX 76086-5864
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00209W
BCBS OF TEXAS
TX
05
—
085155203
—
TX
01
—
CT1051
MEDICARE RAILROAD
TX
Enumeration date
03/01/2007
Last updated
09/08/2011
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