Provider Demographics
NPI:1558480590
Name:ADVANCED KIDNEY SPECIALISTS PC
Entity Type:Organization
Organization Name:ADVANCED KIDNEY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHYAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-984-8390
Mailing Address - Street 1:2782 N HIGHLAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1798
Mailing Address - Country:US
Mailing Address - Phone:731-984-8390
Mailing Address - Fax:731-984-8392
Practice Address - Street 1:2782 N HIGHLAND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1798
Practice Address - Country:US
Practice Address - Phone:731-984-8390
Practice Address - Fax:731-984-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714241Medicare ID - Type UnspecifiedGROUP NUMBER