Provider Demographics
NPI:1831281849
Name:HUNTSVILLE RENAL CLINIC, PC
Entity Type:Organization
Organization Name:HUNTSVILLE RENAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMELSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-533-7676
Mailing Address - Street 1:810 FRANKLIN ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4311
Mailing Address - Country:US
Mailing Address - Phone:256-533-7676
Mailing Address - Fax:256-533-3171
Practice Address - Street 1:810 FRANKLIN ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4311
Practice Address - Country:US
Practice Address - Phone:256-533-7676
Practice Address - Fax:256-533-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000046537Medicaid
AL529908020Medicaid
ALH920Medicare ID - Type Unspecified