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General NPI Number Information
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NPI Number | 1053073353
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Entity Type | Organization
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Legal Business Name | NITHO LLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 1634 MISTLETOE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76104-4012
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Country | US
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Telephone | 817-489-5778
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67
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City | SHANNON
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State | AL
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Zip | 35142-0067
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Country | US
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Telephone | 205-601-1746
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Fax | 205-847-5261
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS RAJAN
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Credential | MD
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Telephone | 888-212-4243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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