Provider Demographics
NPI:1306363635
Name:NEPHROMED ASSOCIATES PA
Entity Type:Organization
Organization Name:NEPHROMED ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-723-8210
Mailing Address - Street 1:4002 S LOOP 256
Mailing Address - Street 2:F
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4002 S LOOP 256
Practice Address - Street 2:STE F
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8493
Practice Address - Country:US
Practice Address - Phone:903-723-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330638884OtherBCBS