Basic Information
Provider Information
NPI: 1053073353
EntityType: 2
ReplacementNPI:  
OrganizationName: NITHO LLC
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Mailing Information
Address1: PO BOX 67
Address2:  
City: SHANNON
State: AL
PostalCode: 351420067
CountryCode: US
TelephoneNumber: 2056011746
FaxNumber: 2058475261
Practice Location
Address1: 1634 MISTLETOE BLVD
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761044012
CountryCode: US
TelephoneNumber: 8174895778
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/13/2021
LastUpdateDate: 10/13/2021
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AuthorizedOfficialLastName: RAJAN
AuthorizedOfficialFirstName: THOMAS
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AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 8882124243
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate: 10/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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