Basic Information
| Provider Information | |||||||||
| NPI: | 1548785116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPHROLOGY & INTERNAL MEDICINE, INC. | ||||||||
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| OtherOrganizationName: | NEPHROLOGY & INTERNAL MEDICINE INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5510 S EAST ST STE H | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462271938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179248425 | ||||||||
| FaxNumber: | 3179248424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 N SENATE AVE STE A | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462022211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305735000 | ||||||||
| FaxNumber: | 3176340921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2017 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | BAIRD | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3179248425 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.