Healthcare Provider Details

I. General information

NPI: 1134150170
Provider Name (Legal Business Name): NEPHROLOGY CONSULTANTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GERMANTOWN BEND CV
CORDOVA TN
38018-4243
US

IV. Provider business mailing address

301 GERMANTOWN BEND CV
CORDOVA TN
38018-4243
US

V. Phone/Fax

Practice location:
  • Phone: 901-753-6474
  • Fax: 901-753-5923
Mailing address:
  • Phone: 901-753-6474
  • Fax: 901-753-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier009411500
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier076826901
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer
# 3
Identifier2062762
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 4
Identifier200218560
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name: WALTER L. WALSH JR.
Title or Position: PRESIDENT
Credential:
Phone: 901-753-6474