Healthcare Provider Details

I. General information

NPI: 1538348388
Provider Name (Legal Business Name): CENTER FOR INTERNAL MEDICINE HYPER KIDNEY DISEASE & CRITICAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N ROBINSON ST STE 305
RICHMOND VA
23220-4461
US

IV. Provider business mailing address

110 N ROBINSON ST STE 305
RICHMOND VA
23220-4461
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-2610
  • Fax:
Mailing address:
  • Phone: 804-780-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0101030754
License Number StateVA

VIII. Authorized Official

Name: DR. SHRIDHAR VENKATRAMAN BHAT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-780-2610