Provider Demographics
NPI:1659490738
Name:SIGNATURE NEPHROLOGY GROUP PC
Entity Type:Organization
Organization Name:SIGNATURE NEPHROLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-885-0277
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-885-0277
Mailing Address - Fax:866-406-0720
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-885-0277
Practice Address - Fax:866-406-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3378137Medicare ID - Type Unspecified