Provider Demographics
NPI:1730104647
Name:THE CENTER FOR RENAL MEDICINE, INC.
Entity Type:Organization
Organization Name:THE CENTER FOR RENAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRETES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-873-1009
Mailing Address - Street 1:739 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3562
Mailing Address - Country:US
Mailing Address - Phone:757-873-1009
Mailing Address - Fax:757-873-7689
Practice Address - Street 1:739 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 801
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3562
Practice Address - Country:US
Practice Address - Phone:757-873-1009
Practice Address - Fax:757-873-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACF9221OtherRAILROAD MEDICARE
VA382729OtherANTHEM BLUE CROSS OF VA
VAC02028Medicare ID - Type Unspecified