Provider Demographics
NPI:1679769434
Name:INTERVENTIONAL NEPHROLOGY SPECIALISTS PLLC
Entity Type:Organization
Organization Name:INTERVENTIONAL NEPHROLOGY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:RASHAD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-726-1130
Mailing Address - Street 1:2200 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4205
Mailing Address - Country:US
Mailing Address - Phone:901-482-3192
Mailing Address - Fax:901-726-1132
Practice Address - Street 1:2200 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4205
Practice Address - Country:US
Practice Address - Phone:901-482-3192
Practice Address - Fax:901-726-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI49076Medicare UPIN