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General NPI Number Information
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NPI Number | 1083283972
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Entity Type | Organization
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Legal Business Name | FOOTHILLS NEPHROLOGY AND HYPERTENSION CENTER
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 1321 N BRIDGE ST
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City | ELKIN
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State | NC
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Zip | 28621-2303
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Country | US
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Telephone | 336-530-4491
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Fax | 949-561-5143
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Provider Business Mailing Address
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Address Line | 1321 N BRIDGE ST
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City | ELKIN
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State | NC
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Zip | 28621-2303
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Country | US
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Telephone | 336-530-4491
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Fax | 949-561-5143
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINA MARIE QUALHEIM
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Credential | DNP-C
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Telephone | 336-530-4491
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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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