Provider Demographics
NPI:1013189539
Name:RENAL MEDICAL GROUP
Entity Type:Organization
Organization Name:RENAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:559-625-4630
Mailing Address - Street 1:515 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2616
Mailing Address - Country:US
Mailing Address - Phone:559-625-4630
Mailing Address - Fax:
Practice Address - Street 1:515 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2616
Practice Address - Country:US
Practice Address - Phone:559-625-4630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA040793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851452148Medicare UPIN