Provider Demographics
NPI:1710113881
Name:NEPHROLOGY CONSULTANTS, INC.
Entity Type:Organization
Organization Name:NEPHROLOGY CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EMMETT
Authorized Official - Last Name:CUDDIHEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:636-458-3664
Mailing Address - Street 1:18000 INDIAN TREE RUN
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MO
Mailing Address - Zip Code:63038-1576
Mailing Address - Country:US
Mailing Address - Phone:636-458-3664
Mailing Address - Fax:314-821-3481
Practice Address - Street 1:18000 INDIAN TREE RUN
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MO
Practice Address - Zip Code:63038-1576
Practice Address - Country:US
Practice Address - Phone:636-458-3664
Practice Address - Fax:314-821-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20663920Medicaid
MO000004128Medicare PIN
MO20663920Medicaid