Provider Demographics
NPI:1629054960
Name:CHARLESTON NEPHROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CHARLESTON NEPHROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-767-9312
Mailing Address - Street 1:3815 FABER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8533
Mailing Address - Country:US
Mailing Address - Phone:843-767-9312
Mailing Address - Fax:843-767-9313
Practice Address - Street 1:3815 FABER PLACE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8533
Practice Address - Country:US
Practice Address - Phone:843-767-9312
Practice Address - Fax:843-767-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2517Medicaid
SCGP2517Medicaid
6317Medicare PIN
SCGP6317Medicare PIN
SCH31645Medicare UPIN
SCG91086Medicare UPIN
SCP89412Medicare UPIN
SCP01873Medicare UPIN
SC2517Medicaid
SC6317Medicare PIN
SCE97914Medicare UPIN
SCH78680Medicare UPIN
SCC60633Medicare UPIN
SCG57327Medicare UPIN