Healthcare Provider Details

I. General information

NPI: 1225163116
Provider Name (Legal Business Name): PRIMROSE NEPHROLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E EVERGREEN ST
SPRINGFIELD MO
65803-4300
US

IV. Provider business mailing address

1540 E EVERGREEN ST
SPRINGFIELD MO
65803-4300
US

V. Phone/Fax

Practice location:
  • Phone: 417-823-2900
  • Fax: 417-886-2774
Mailing address:
  • Phone: 417-823-2900
  • Fax: 417-886-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMO112417
License Number StateMO

VIII. Authorized Official

Name: DR. ROBERT C MAY
Title or Position: PRESIDENT
Credential: MD
Phone: 417-823-2900