Healthcare Provider Details

I. General information

NPI: 1750576088
Provider Name (Legal Business Name): KIDNEY CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 JOHNS HOPKINS DR
GREENVILLE NC
27834-7224
US

IV. Provider business mailing address

990 JOHNS HOPKINS DR
GREENVILLE NC
27834-7224
US

V. Phone/Fax

Practice location:
  • Phone: 252-754-2900
  • Fax: 252-754-2999
Mailing address:
  • Phone: 252-754-2900
  • Fax: 252-754-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD HOSMER MERRILL
Title or Position: DIRECTOR
Credential: MD
Phone: 252-754-2900