Basic Information
| Provider Information | |||||||||
| NPI: | 1104075829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPHRON MEDICAL, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 182255 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432182255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144305712 | ||||||||
| FaxNumber: | 6144305742 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 N PICKAWAY ST | ||||||||
| Address2: | |||||||||
| City: | CIRCLEVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431131447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404742126 | ||||||||
| FaxNumber: | 7404208652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2008 | ||||||||
| LastUpdateDate: | 09/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | WATHEN | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7404742126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 35077894 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.