Provider Demographics
NPI:1275614430
Name:SANDHILLS NEPHROLOGY AND INTERNAL MEDICINE, P.A.
Entity Type:Organization
Organization Name:SANDHILLS NEPHROLOGY AND INTERNAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:ROMEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-323-1671
Mailing Address - Street 1:1218 WALTER REED RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4440
Mailing Address - Country:US
Mailing Address - Phone:910-323-1671
Mailing Address - Fax:910-323-9656
Practice Address - Street 1:1218 WALTER REED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4440
Practice Address - Country:US
Practice Address - Phone:910-323-1671
Practice Address - Fax:910-323-9656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790197CMedicaid
NC0197COtherBLUE CROSS/BLUE SHIELD
NC0197COtherBLUE CROSS/BLUE SHIELD
NC0197COtherBLUE CROSS/BLUE SHIELD