Provider Demographics
NPI:1982635785
Name:WEST BRANCH NEPHROLOGY ASSOCIATES LTD
Entity Type:Organization
Organization Name:WEST BRANCH NEPHROLOGY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:STEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-326-8080
Mailing Address - Street 1:1660 SYCAMORE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-9314
Mailing Address - Country:US
Mailing Address - Phone:570-326-8080
Mailing Address - Fax:570-326-2733
Practice Address - Street 1:1660 SYCAMORE RD STE C
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9314
Practice Address - Country:US
Practice Address - Phone:570-326-8080
Practice Address - Fax:570-326-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 003541-L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA015619Medicare ID - Type Unspecified