Provider Demographics
NPI:1497387997
Name:NEPHROLOGY CLINIC PC
Entity Type:Organization
Organization Name:NEPHROLOGY CLINIC PC
Other - Org Name:THE NEPHROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TOBEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-493-7733
Mailing Address - Street 1:3351 EASTBROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5744
Mailing Address - Country:US
Mailing Address - Phone:970-493-7733
Mailing Address - Fax:970-493-8745
Practice Address - Street 1:1000 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3290
Practice Address - Country:US
Practice Address - Phone:970-493-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEPHROLOGY CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-12
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty