Provider Demographics
NPI:1134170822
Name:VALLEY HYPERTENSION-NEPHROLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:VALLEY HYPERTENSION-NEPHROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-535-2111
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0220
Mailing Address - Country:US
Mailing Address - Phone:252-535-2111
Mailing Address - Fax:252-535-1295
Practice Address - Street 1:937 GREGORY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-535-2111
Practice Address - Fax:252-535-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890265VMedicaid
NC0265VOtherBCBS NC
NC0265VOtherBCBS NC