Provider Demographics
NPI:1184802704
Name:NEPHROLOGY AND HYPERTENSION ASSOCIATES, LTD
Entity type:Organization
Organization Name:NEPHROLOGY AND HYPERTENSION ASSOCIATES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-844-4711
Mailing Address - Street 1:1542 MEDICAL PARK CIR
Mailing Address - Street 2:1542 MEDICAL PARK CIRCLE
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6560
Mailing Address - Country:US
Mailing Address - Phone:662-844-4711
Mailing Address - Fax:
Practice Address - Street 1:1542 MEDICAL PARK CIR
Practice Address - Street 2:1542 MEDICAL PARK CIRCLE
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6560
Practice Address - Country:US
Practice Address - Phone:662-844-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACB3265Medicare PIN