Provider Demographics
NPI:1750450698
Name:CENTRAL NEPHROLOGY MEDICAL GRP INC
Entity type:Organization
Organization Name:CENTRAL NEPHROLOGY MEDICAL GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISOGNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-323-2847
Mailing Address - Street 1:5030 OFFICE PARK DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0612
Mailing Address - Country:US
Mailing Address - Phone:661-323-2847
Mailing Address - Fax:661-323-0566
Practice Address - Street 1:5030 OFFICE PARK DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0612
Practice Address - Country:US
Practice Address - Phone:661-323-2847
Practice Address - Fax:661-323-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ74656ZMedicaid
ZZZ74656ZMedicare ID - Type Unspecified