Healthcare Provider Details

I. General information

NPI: 1073519898
Provider Name (Legal Business Name): NEPHROLOGY AND HYPERTENSION ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W BROADWAY
COLUMBIA MO
65203-2125
US

IV. Provider business mailing address

1205 W BROADWAY
COLUMBIA MO
65203-2125
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-0642
  • Fax: 573-449-1787
Mailing address:
  • Phone: 573-449-4936
  • Fax: 573-449-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA S DODGE
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 573-499-0642