Provider Demographics
NPI:1538113691
Name:INDEPENDENT NEPHROLOGY SERVICES, INC.
Entity Type:Organization
Organization Name:INDEPENDENT NEPHROLOGY SERVICES, INC.
Other - Org Name:INS - IREDELL COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-947-2341
Mailing Address - Street 1:7650 SE 27TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3060
Mailing Address - Country:US
Mailing Address - Phone:206-236-5001
Mailing Address - Fax:206-236-5002
Practice Address - Street 1:124 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5537
Practice Address - Country:US
Practice Address - Phone:704-663-3534
Practice Address - Fax:704-663-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3402656Medicaid
NC342656Medicare Oscar/Certification