Provider Demographics
NPI:1851379168
Name:SANFORD NEPHROLOGY CLINIC PA
Entity Type:Organization
Organization Name:SANFORD NEPHROLOGY CLINIC PA
Other - Org Name:SANFORD NEPHROLOGY CLINIC, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:919-356-8504
Mailing Address - Street 1:4552 HIGHWAY 421
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0627
Mailing Address - Country:US
Mailing Address - Phone:919-356-8504
Mailing Address - Fax:919-708-4696
Practice Address - Street 1:1139 CARTHAGE ST
Practice Address - Street 2:STE 105
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-774-2875
Practice Address - Fax:919-708-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8967669Medicaid
C82327Medicare UPIN
NC2346319Medicare PIN