Provider Demographics
NPI:1013943109
Name:NEPHROLOGY & INTERNAL MEDICINE, INC.
Entity Type:Organization
Organization Name:NEPHROLOGY & INTERNAL MEDICINE, INC.
Other - Org Name:INDIANA KIDNEY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-924-8425
Mailing Address - Street 1:5510 S EAST ST STE H
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1938
Mailing Address - Country:US
Mailing Address - Phone:317-924-8425
Mailing Address - Fax:317-924-8424
Practice Address - Street 1:5510 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1938
Practice Address - Country:US
Practice Address - Phone:317-924-8425
Practice Address - Fax:317-924-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN-001207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100061370Medicaid
IN100061370Medicaid