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General NPI Number Information
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NPI Number | 1063412633
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY INC
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6201 NIMTZ PARKWAY
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City | SOUTH BEND
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State | IN
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Zip | 46628-6117
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Country | US
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Telephone | 574-246-7000
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Fax | 574-246-7007
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Provider Business Mailing Address
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Address Line | 221 RED COACH DRIVE SUITE D
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City | MISHAWAKA
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State | IN
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Zip | 46545-3519
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Country | US
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Telephone | 574-273-6787
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Fax | 574-968-0882
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Authorized Official
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Title or Position | CEO
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Name | KEITH MENTZ
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Credential |
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Telephone | 574-273-6787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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