Provider Demographics
NPI:1720402217
Name:VSP NEPHROLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:VSP NEPHROLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-533-4422
Mailing Address - Street 1:20450 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-6030
Mailing Address - Country:US
Mailing Address - Phone:352-533-4422
Mailing Address - Fax:352-489-5333
Practice Address - Street 1:20450 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-6030
Practice Address - Country:US
Practice Address - Phone:352-533-4422
Practice Address - Fax:352-489-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty