Provider Demographics
NPI:1639129224
Name:CAPE GIRARDEAU NEPHROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:CAPE GIRARDEAU NEPHROLOGY ASSOCIATES, PC
Other - Org Name:NEPHROLOGY ASSOCIATES, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-334-9564
Mailing Address - Street 1:1349 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1727
Mailing Address - Country:US
Mailing Address - Phone:573-334-9564
Mailing Address - Fax:573-334-1879
Practice Address - Street 1:1349 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1727
Practice Address - Country:US
Practice Address - Phone:573-334-9564
Practice Address - Fax:573-334-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C446OtherBLUE CROSS BLUE SHIELD
CI5170OtherRAIL ROAD MEDICARE
MOH8238OtherHEALTHLINK
AR145675002Medicaid
MO500867403Medicaid
MO500908306Medicaid
MO117672OtherBLUE CROSS BLUE SHIELD
=========OtherCHAMPUS
MOH8238OtherHEALTHLINK
MO990001443Medicare PIN