Provider Demographics
NPI:1982878450
Name:FLORIDA KIDNEY & HYPERTENSION CLINIC INC
Entity Type:Organization
Organization Name:FLORIDA KIDNEY & HYPERTENSION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAMBUGANIPALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-451-1005
Mailing Address - Street 1:2140 KINGSLEY AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5180
Mailing Address - Country:US
Mailing Address - Phone:904-529-5252
Mailing Address - Fax:904-529-5253
Practice Address - Street 1:2140 KINGSLEY AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-529-5252
Practice Address - Fax:904-529-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93749207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54259OtherBCBS
FL161729Medicare UPIN