Provider Demographics
NPI:1790797918
Name:SOUTHERN INDIANA NEPHROLOGY AND HYPERTENSION INC
Entity Type:Organization
Organization Name:SOUTHERN INDIANA NEPHROLOGY AND HYPERTENSION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PIKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-375-0272
Mailing Address - Street 1:940 N MARR RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2610
Mailing Address - Country:US
Mailing Address - Phone:812-375-0272
Mailing Address - Fax:812-375-1093
Practice Address - Street 1:940 N MARR RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2610
Practice Address - Country:US
Practice Address - Phone:812-375-0272
Practice Address - Fax:812-375-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200423640Medicaid
IN200423640Medicaid