Provider Demographics
NPI:1558771964
Name:NEPHROLOGY PHYSICIANS, P.A.
Entity Type:Organization
Organization Name:NEPHROLOGY PHYSICIANS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-831-2430
Mailing Address - Street 1:8901 W 74TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-831-2430
Mailing Address - Fax:913-831-0108
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-831-2430
Practice Address - Fax:913-831-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100193330AMedicaid
6330000Medicare PIN