Provider Demographics
NPI:1003837337
Name:NEPHROLOGY CONSULTANTS OF PINELLAS LLC
Entity Type:Organization
Organization Name:NEPHROLOGY CONSULTANTS OF PINELLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-441-3724
Mailing Address - Street 1:617 LAKEVIEW RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3338
Mailing Address - Country:US
Mailing Address - Phone:727-441-3724
Mailing Address - Fax:727-442-2594
Practice Address - Street 1:617 LAKEVIEW RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3338
Practice Address - Country:US
Practice Address - Phone:727-441-3724
Practice Address - Fax:727-442-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3745Medicare PIN