Basic Information
| Provider Information | |||||||||
| NPI: | 1669739017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREAT FALLS NEPHROLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 11TH AVE S | ||||||||
| Address2: | SUITE 29 | ||||||||
| City: | GREAT FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594055263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066223357 | ||||||||
| FaxNumber: | 4066225477 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 11TH AVE S | ||||||||
| Address2: | SUITE 29 | ||||||||
| City: | GREAT FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594055263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066223357 | ||||||||
| FaxNumber: | 4066225477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2012 | ||||||||
| LastUpdateDate: | 05/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | PARAMBI | ||||||||
| AuthorizedOfficialFirstName: | VARGHESE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4066225955 | ||||||||
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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 | 10588 | MT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 10588 | 01 | MT | LICENSE | OTHER |