Provider Demographics
NPI:1932203023
Name:SOUTH WEST NEPHROLOGY LLC
Entity Type:Organization
Organization Name:SOUTH WEST NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KULBIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:PANNU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-237-7112
Mailing Address - Street 1:8523 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NO ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1856
Mailing Address - Country:US
Mailing Address - Phone:440-237-7112
Mailing Address - Fax:440-237-1406
Practice Address - Street 1:8523 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NO ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1856
Practice Address - Country:US
Practice Address - Phone:440-237-7112
Practice Address - Fax:440-237-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2517155Medicaid