Basic Information
| Provider Information | |||||||||
| NPI: | 1447349949 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEPHROLOGY AND HYPERTENSION CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 522 E 11TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362074770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562375302 | ||||||||
| FaxNumber: | 2562375368 | ||||||||
| Practice Location | |||||||||
| Address1: | 522 E 11TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362074770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562375302 | ||||||||
| FaxNumber: | 2562375368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 09/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | ZINN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2562375302 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 3525 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CE8762 | 01 | AL | RAILROAD MEDICARE GROUP NUMBER | OTHER | 529503600 | 05 | AL | MEDICAID | F216 | 01 | AL | MEDICARE GROUP NUMBER | OTHER |