Provider Demographics
NPI:1518996719
Name:NEPHROLOGY PHYSICIANS LLC
Entity Type:Organization
Organization Name:NEPHROLOGY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PORILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-273-6787
Mailing Address - Street 1:710 PARK PL STE 200
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3519
Mailing Address - Country:US
Mailing Address - Phone:574-273-6767
Mailing Address - Fax:574-273-6764
Practice Address - Street 1:710 PARK PLACE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3519
Practice Address - Country:US
Practice Address - Phone:574-273-6767
Practice Address - Fax:574-968-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200241320AMedicaid
IN200241320AMedicaid