Provider Demographics
NPI:1609804210
Name:SOUTHWESTERN NEPHROLOGY INC
Entity Type:Organization
Organization Name:SOUTHWESTERN NEPHROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBRAMONIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-228-1303
Mailing Address - Street 1:764 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2756
Mailing Address - Country:US
Mailing Address - Phone:724-228-1303
Mailing Address - Fax:724-228-1513
Practice Address - Street 1:764 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2756
Practice Address - Country:US
Practice Address - Phone:724-228-1303
Practice Address - Fax:724-228-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035880L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0181888Medicaid
WV0009503000Medicaid
WV0009503000Medicaid
WV9274781Medicare ID - Type Unspecified
PA577334Medicare ID - Type Unspecified
B35088Medicare UPIN