Provider Demographics
NPI:1871679514
Name:NEPHROLOGY ASSOCIATES SC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES SC
Other - Org Name:NEPHROLOGY ASSOCIATES OF WAUKESHA, SC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-524-1024
Mailing Address - Street 1:1260 SENTRY DR STE 140
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5990
Mailing Address - Country:US
Mailing Address - Phone:262-524-1024
Mailing Address - Fax:262-524-8767
Practice Address - Street 1:1260 SENTRY DR STE 140
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5990
Practice Address - Country:US
Practice Address - Phone:262-524-1024
Practice Address - Fax:262-524-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32807900Medicaid
WI000068705Medicare PIN