Provider Demographics
NPI:1215020318
Name:TUSCALOOSA NEPHROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:TUSCALOOSA NEPHROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-556-5541
Mailing Address - Street 1:1850 MCFARLAND BLVD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2138
Mailing Address - Country:US
Mailing Address - Phone:205-556-5541
Mailing Address - Fax:205-554-7937
Practice Address - Street 1:1850 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2138
Practice Address - Country:US
Practice Address - Phone:205-556-5541
Practice Address - Fax:205-554-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCN3399OtherMEDICARE RAILROAD
AL528903280Medicaid
ALF835Medicare PIN