Provider Demographics
NPI:1962507285
Name:RENAL ASSOCIATES OF CENTRAL IN
Entity Type:Organization
Organization Name:RENAL ASSOCIATES OF CENTRAL IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-298-4120
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-0506
Mailing Address - Country:US
Mailing Address - Phone:765-298-4120
Mailing Address - Fax:765-751-3377
Practice Address - Street 1:3025 NORTH OAKWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3987
Practice Address - Country:US
Practice Address - Phone:765-298-4120
Practice Address - Fax:765-751-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042569A207RN0300X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100413220Medicaid
IN200112430Medicaid
IN100413220BMedicaid
IN100413220BMedicaid
IN218870Medicare PIN
IN218870AMedicare PIN