Basic Information
| Provider Information | |||||||||
| NPI: | 1053499251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPHROLOGY GROUP OF HOPKINSVILLE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73 | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708890282 | ||||||||
| FaxNumber: | 2708878340 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 A BURLEY AVE | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708890282 | ||||||||
| FaxNumber: | 2708878340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RADIX | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2708890282 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.