Provider Demographics
NPI:1619900131
Name:NEPHROLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:NEPHROLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-258-6522
Mailing Address - Street 1:544 HEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1492
Mailing Address - Country:US
Mailing Address - Phone:386-258-6522
Mailing Address - Fax:386-254-8803
Practice Address - Street 1:544 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1492
Practice Address - Country:US
Practice Address - Phone:386-258-6522
Practice Address - Fax:386-254-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40336Medicare ID - Type UnspecifiedGROUP
FL40336AMedicare ID - Type UnspecifiedGROUP