Provider Demographics
NPI:1073519898
Name:NEPHROLOGY AND HYPERTENSION ASSOCIATES
Entity Type:Organization
Organization Name:NEPHROLOGY AND HYPERTENSION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:573-499-0642
Mailing Address - Street 1:1205 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2125
Mailing Address - Country:US
Mailing Address - Phone:573-449-4936
Mailing Address - Fax:573-449-6795
Practice Address - Street 1:1205 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2125
Practice Address - Country:US
Practice Address - Phone:573-499-0642
Practice Address - Fax:573-449-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507480226Medicaid
MOCH1443OtherRAILROAD MEDICARE