Provider Demographics
NPI:1558815720
Name:NEPHROLOGY MANAGEMENT LLC
Entity Type:Organization
Organization Name:NEPHROLOGY MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-4893
Mailing Address - Street 1:PO BOX 83130
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-3130
Mailing Address - Country:US
Mailing Address - Phone:225-767-4893
Mailing Address - Fax:
Practice Address - Street 1:5131 ODONOVAN DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4791
Practice Address - Country:US
Practice Address - Phone:225-767-4893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL ASSOCIATES OF BATON ROUGE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty