MEDICARE: INDEPENDENT NEPHROLOGY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1699729756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT NEPHROLOGY SERVICES, INC.

Provider Business Mailing Address
First Line	:	60 WHEATON AVE
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-8691
Country	:	US
Telephone Number	:	919-554-8534
Fax Number	:	919-554-8932

Provider Business Practice Location Address
First Line	:	60 WHEATON AVE
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-8691
Country	:	US
Telephone Number	:	919-554-8534
Fax Number	:	919-554-8932

Authorized Official
Title or Position	:	VP AND TREASURER
Name	:	MARK R FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	02/25/2015

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