Provider Demographics
NPI:1750576088
Name:KIDNEY CENTER PA
Entity type:Organization
Organization Name:KIDNEY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HOSMER
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-754-2900
Mailing Address - Street 1:990 JOHNS HOPKINS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7224
Mailing Address - Country:US
Mailing Address - Phone:252-754-2900
Mailing Address - Fax:252-754-2999
Practice Address - Street 1:990 JOHNS HOPKINS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7224
Practice Address - Country:US
Practice Address - Phone:252-754-2900
Practice Address - Fax:252-754-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0266VOtherBCBS
NC890266VMedicaid