Provider Demographics
NPI:1083885263
Name:CENTRAL NEPHROLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:CENTRAL NEPHROLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-325-4754
Mailing Address - Street 1:5030 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0612
Mailing Address - Country:US
Mailing Address - Phone:661-325-4754
Mailing Address - Fax:661-323-0566
Practice Address - Street 1:5030 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0612
Practice Address - Country:US
Practice Address - Phone:661-325-4754
Practice Address - Fax:661-323-0566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL NEPHROLOGY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB86566FMedicaid