Provider Demographics
NPI:1356471486
Name:NEPHROLOGY AND HYPERTENSION
Entity Type:Organization
Organization Name:NEPHROLOGY AND HYPERTENSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:PBT
Authorized Official - Phone:304-327-1873
Mailing Address - Street 1:510 CHERRY ST
Mailing Address - Street 2:306
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3338
Mailing Address - Country:US
Mailing Address - Phone:304-327-1873
Mailing Address - Fax:304-327-1878
Practice Address - Street 1:510 CHERRY ST
Practice Address - Street 2:306
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3338
Practice Address - Country:US
Practice Address - Phone:304-327-1873
Practice Address - Fax:304-327-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV72025207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVNE9367931Medicare PIN