Provider Demographics
NPI:1659417863
Name:NEPHROLOGY PC
Entity Type:Organization
Organization Name:NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:BUCHSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-243-3161
Mailing Address - Street 1:501 SW 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4536
Mailing Address - Country:US
Mailing Address - Phone:515-243-3161
Mailing Address - Fax:515-243-5687
Practice Address - Street 1:501 SW 7TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4536
Practice Address - Country:US
Practice Address - Phone:515-243-3161
Practice Address - Fax:515-243-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0233296Medicaid
IA0233296Medicaid