Provider Demographics
NPI:1710098090
Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON
Entity Type:Organization
Organization Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON
Other - Org Name:KIDNEY CARE OF CENTRAL INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-626-6239
Mailing Address - Street 1:1627 COLE BLVD
Mailing Address - Street 2:BLDG18
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3315
Mailing Address - Country:US
Mailing Address - Phone:303-626-6239
Mailing Address - Fax:866-917-5396
Practice Address - Street 1:1140 W JEFFERSON ST
Practice Address - Street 2:B
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2101
Practice Address - Country:US
Practice Address - Phone:317-736-4337
Practice Address - Fax:317-736-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200865690AMedicaid
IN249080Medicare PIN