Provider Demographics
NPI:1467403758
Name:NEPHROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-491-6419
Mailing Address - Street 1:1401 PROFESSIONAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8011
Mailing Address - Country:US
Mailing Address - Phone:812-491-6419
Mailing Address - Fax:812-491-6419
Practice Address - Street 1:1401 PROFESSIONAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8011
Practice Address - Country:US
Practice Address - Phone:812-491-6419
Practice Address - Fax:812-491-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCC9243OtherRAILROAD MEDICARE
IN1002461900Medicaid
IN100246190AMedicaid