Healthcare Provider Details

I. General information

NPI: 1114794286
Provider Name (Legal Business Name): NEPHROLOGY AND HYPERTENSION ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
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: 573-499-0642
  • Fax: 573-449-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA DODGE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 573-499-0642