Provider Demographics
NPI:1962451492
Name:INDEPENDENT NEPHROLOGY SERVICES, LLC
Entity type:Organization
Organization Name:INDEPENDENT NEPHROLOGY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:3158 FREEDOM DR
Mailing Address - Street 2:STE 2102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3870
Mailing Address - Country:US
Mailing Address - Phone:980-341-1900
Mailing Address - Fax:704-405-7407
Practice Address - Street 1:3158 FREEDOM DR
Practice Address - Street 2:STE 2102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3870
Practice Address - Country:US
Practice Address - Phone:980-341-1900
Practice Address - Fax:704-405-7407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-10
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3402654Medicaid
NC342654Medicare Oscar/Certification