Provider Demographics
NPI:1922087121
Name:CENTRAL MISSOURI NEPHROLOGY ASSOCIATES,LLC
Entity Type:Organization
Organization Name:CENTRAL MISSOURI NEPHROLOGY ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-447-4400
Mailing Address - Street 1:1100 CLUB VILLAGE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4411
Mailing Address - Country:US
Mailing Address - Phone:573-447-4400
Mailing Address - Fax:573-303-0140
Practice Address - Street 1:1100 CLUB VILLAGE DR STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4411
Practice Address - Country:US
Practice Address - Phone:573-447-4400
Practice Address - Fax:573-303-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2H47207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202448718Medicaid
000091532Medicare PIN
MO202448718Medicaid