Provider Demographics
NPI:1093450652
Name:RIVER CITY NEPHROLOGY PLLC
Entity Type:Organization
Organization Name:RIVER CITY NEPHROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RABIE
Authorized Official - Middle Name:I
Authorized Official - Last Name:ADAM-ELDIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-863-5418
Mailing Address - Street 1:2449 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2037
Mailing Address - Country:US
Mailing Address - Phone:904-730-1225
Mailing Address - Fax:904-341-5457
Practice Address - Street 1:2449 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2037
Practice Address - Country:US
Practice Address - Phone:904-730-1225
Practice Address - Fax:904-341-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty