Provider Demographics
NPI:1811944432
Name:NEPHROLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:NEPHROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LEBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-329-3838
Mailing Address - Street 1:129 N BROOKMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:662-329-3838
Mailing Address - Fax:662-329-2515
Practice Address - Street 1:129 N BROOKMOORE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2024
Practice Address - Country:US
Practice Address - Phone:662-329-3838
Practice Address - Fax:662-329-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015007Medicaid
MS09015007Medicaid