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General NPI Number Information
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NPI Number | 1104925163
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Entity Type | Organization
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Legal Business Name | SOUTHWEST NEPHROLOGY ASSOCIATES, S.C.
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 16605 107TH ST
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City | ORLAND PARK
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State | IL
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Zip | 60467-9016
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Country | US
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Telephone | 708-226-9860
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W 22ND ST STE 200
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City | OAK BROOK
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State | IL
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Zip | 60523-1563
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Country | US
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Telephone | 630-573-5000
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Fax | 708-422-7816
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | MS. KRISTIN JOYCE
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Credential |
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Telephone | 331-216-1163
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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 | 042618498
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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