Provider Demographics
NPI:1194357459
Name:SOUTHERN KIDNEY SPECIALISTS - GRETNA LLC
Entity Type:Organization
Organization Name:SOUTHERN KIDNEY SPECIALISTS - GRETNA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-564-4983
Mailing Address - Street 1:PO BOX 1800
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-1800
Mailing Address - Country:US
Mailing Address - Phone:504-722-9086
Mailing Address - Fax:
Practice Address - Street 1:959 BEHRMAN HWY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-4550
Practice Address - Country:US
Practice Address - Phone:504-391-1041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment