Provider Demographics
NPI:1053073353
Name:NITHO LLC
Entity Type:Organization
Organization Name:NITHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-212-4243
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:AL
Mailing Address - Zip Code:35142-0067
Mailing Address - Country:US
Mailing Address - Phone:205-601-1746
Mailing Address - Fax:205-847-5261
Practice Address - Street 1:1634 MISTLETOE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4012
Practice Address - Country:US
Practice Address - Phone:817-489-5778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty