Provider Demographics
NPI:1790174027
Name:EASTERN NEPHROLOGY
Entity Type:Organization
Organization Name:EASTERN NEPHROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DOO
Authorized Official - Phone:205-699-1632
Mailing Address - Street 1:48 MEDICAL PARK DR E
Mailing Address - Street 2:STE151
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3400
Mailing Address - Country:US
Mailing Address - Phone:205-699-1632
Mailing Address - Fax:866-546-2124
Practice Address - Street 1:48 MEDICAL PARK DR E
Practice Address - Street 2:STE151
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3400
Practice Address - Country:US
Practice Address - Phone:205-699-1632
Practice Address - Fax:866-546-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1093896466OtherNPI
ALJ862Medicare UPIN