Healthcare Provider Details

I. General information

NPI: 1356347439
Provider Name (Legal Business Name): RENAL MEDICINE ASSOCIATES LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4679
US

IV. Provider business mailing address

3821 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4679
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-7400
  • Fax: 505-998-7741
Mailing address:
  • Phone: 505-998-7400
  • Fax: 505-998-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNM

VIII. Authorized Official

Name: DR. JAYANT KUMAR
Title or Position: PHYSICIAN/NEPHROLOGY
Credential: M.D.
Phone: 505-998-7400