Basic Information
| Provider Information | |||||||||
| NPI: | 1952301525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPHROLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 RED COACH DRIVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465453519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742736767 | ||||||||
| FaxNumber: | 5742736757 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 MONROE STREET | ||||||||
| Address2: | |||||||||
| City: | LAPORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463505249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193240944 | ||||||||
| FaxNumber: | 2193253015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MENTZ | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5742736787 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.