Provider Demographics
NPI:1467544643
Name:THE KIDNEY GROUP OF MEMPHIS, PLLC
Entity Type:Organization
Organization Name:THE KIDNEY GROUP OF MEMPHIS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-726-1161
Mailing Address - Street 1:2225 UNION AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4316
Mailing Address - Country:US
Mailing Address - Phone:901-726-1161
Mailing Address - Fax:901-726-0161
Practice Address - Street 1:2225 UNION AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4316
Practice Address - Country:US
Practice Address - Phone:901-726-1161
Practice Address - Fax:901-726-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732740Medicaid
TNA99781Medicare UPIN
TN3732740Medicaid